Provider Demographics
NPI:1922008143
Name:KHAN, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
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 1:10694 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1816
Mailing Address - Country:US
Mailing Address - Phone:844-247-2467
Mailing Address - Fax:951-335-5468
Practice Address - Street 1:10694 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1816
Practice Address - Country:US
Practice Address - Phone:844-247-2467
Practice Address - Fax:951-335-5468
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC137550207L00000X, 207LP2900X
IL036101678207LP2900X
IN01057031A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H49735Medicare UPIN