Provider Demographics
NPI:1780993360
Name:MOHD QAISAR A KHAN MD INC
Entity type:Organization
Organization Name:MOHD QAISAR A KHAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHD QAISAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-918-4566
Mailing Address - Street 1:1535 W MERCED AVE
Mailing Address - Street 2:STE 302
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3404
Mailing Address - Country:US
Mailing Address - Phone:626-918-4566
Mailing Address - Fax:
Practice Address - Street 1:1535 W MERCED AVE
Practice Address - Street 2:STE 302
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3404
Practice Address - Country:US
Practice Address - Phone:626-918-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31322207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313220Medicaid
CAA87544Medicare UPIN