Provider Demographics
NPI:1265627707
Name:PATHAN, KHALIDA ASSADULLAH (MD)
Entity type:Individual
Prefix:DR
First Name:KHALIDA
Middle Name:ASSADULLAH
Last Name:PATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 MORADA PL
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2425
Mailing Address - Country:US
Mailing Address - Phone:626-696-3692
Mailing Address - Fax:626-696-3784
Practice Address - Street 1:888 MORADA PL
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-2425
Practice Address - Country:US
Practice Address - Phone:626-696-3692
Practice Address - Fax:626-696-3784
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97589207R00000X, 207RH0002X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine