Provider Demographics
NPI:1851684708
Name:KHAWAR MAHMOOD GUL, M.D. INC., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:KHAWAR MAHMOOD GUL, M.D. INC., A MEDICAL CORPORATION
Other - Org Name:LOMPOC VALLEY CARDIOVASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-736-1875
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-0607
Mailing Address - Country:US
Mailing Address - Phone:805-736-1875
Mailing Address - Fax:805-735-9911
Practice Address - Street 1:136 N THIRD ST STE 1
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7002
Practice Address - Country:US
Practice Address - Phone:805-735-7771
Practice Address - Fax:805-735-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89941207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS620ZOtherMEDICARE PTAN