Provider Demographics
NPI:1912008087
Name:KHAN, MOHAMMED Q (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:Q
Last Name:KHAN
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 1:3595 VAN BUREN BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0311
Mailing Address - Country:US
Mailing Address - Phone:951-343-1978
Mailing Address - Fax:951-343-1922
Practice Address - Street 1:3595 VAN BUREN BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0311
Practice Address - Country:US
Practice Address - Phone:951-343-1978
Practice Address - Fax:951-343-1922
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78544174400000X, 207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH75085Medicare UPIN
CAWA78544AMedicare ID - Type UnspecifiedPPIN