Provider Demographics
NPI:1902856917
Name:KHERAJ, NAUSHAD ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:NAUSHAD
Middle Name:ALI
Last Name:KHERAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W WISTARIA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8012
Mailing Address - Country:US
Mailing Address - Phone:626-203-1596
Mailing Address - Fax:
Practice Address - Street 1:3580 SANTA ANITA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2455
Practice Address - Country:US
Practice Address - Phone:626-442-3700
Practice Address - Fax:626-442-3710
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38084207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38084OtherSTATE LICENSE NUMBER
A85100Medicare UPIN
CA00A380840Medicaid
CA00A380841Medicaid