Provider Demographics
NPI:1679908404
Name:HAMMAD O KHAN, MD, INC.
Entity type:Organization
Organization Name:HAMMAD O KHAN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-418-2313
Mailing Address - Street 1:8816 FOOTHILL BLVD
Mailing Address - Street 2:STE 103-205
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7199
Mailing Address - Country:US
Mailing Address - Phone:909-285-6717
Mailing Address - Fax:909-946-8700
Practice Address - Street 1:685 N 13TH AVE
Practice Address - Street 2:STE #11
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4916
Practice Address - Country:US
Practice Address - Phone:909-285-6717
Practice Address - Fax:909-946-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92889207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB225163Medicare PIN
CACA117097Medicare PIN