Provider Demographics
NPI:1942449285
Name:AHMAD KHALIFA, M.D., APC
Entity Type:Organization
Organization Name:AHMAD KHALIFA, M.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHALIFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-546-2496
Mailing Address - Street 1:250 PACIFIC AVE
Mailing Address - Street 2:STE. 528
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3000
Mailing Address - Country:US
Mailing Address - Phone:562-644-9290
Mailing Address - Fax:562-912-7775
Practice Address - Street 1:720 ALAMITOS AVE STE 528
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4726
Practice Address - Country:US
Practice Address - Phone:562-546-2496
Practice Address - Fax:562-562-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79995207R00000X, 207RG0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK8616231OtherDEA
CABK8616231OtherDEA
CA00A799950Medicare PIN