1144268863 NPI number — DR. ADRIAN J KHAW MD

Table of content: DR. ADRIAN J KHAW MD (NPI 1144268863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144268863 NPI number — DR. ADRIAN J KHAW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAW
Provider First Name:
ADRIAN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144268863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10775 PIONEER TRL STE 215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRUCKEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96161-0234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-424-4266
Provider Business Mailing Address Fax Number:
415-520-6633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10775 PIONEER TRL STE 215
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRUCKEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96161-0234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-424-4266
Provider Business Practice Location Address Fax Number:
415-520-6633
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  38125 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: D95231 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: T0257 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 258789 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 68680 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME147496 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 2021014516 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 20680 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: DR.0065494 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 88333 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 036154818 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME95394 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 286231 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: C170906 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD469282 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 830095309 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110568800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1144268863 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 250012079 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000187587 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100199977 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 423421301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110568800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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