Provider Demographics
NPI:1730496480
Name:RUPDEV S. KHOSA, M.D., INC
Entity Type:Organization
Organization Name:RUPDEV S. KHOSA, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RUPDEV
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-445-7500
Mailing Address - Street 1:550 W DUARTE RD
Mailing Address - Street 2:#4
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-7331
Mailing Address - Country:US
Mailing Address - Phone:626-445-7500
Mailing Address - Fax:626-445-7555
Practice Address - Street 1:550 W DUARTE RD
Practice Address - Street 2:#4
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7331
Practice Address - Country:US
Practice Address - Phone:626-445-7500
Practice Address - Fax:626-445-7555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54411208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54411OtherMEDICARE - PALMETTO GBA
CA00A544110Medicaid
CA250011214OtherRAILROAD MEDICARE
CAG94748Medicare UPIN