1417919085 NPI number — KHALID S HASAN M.D.

Table of content: KHALID S HASAN M.D. (NPI 1417919085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417919085 NPI number — KHALID S HASAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASAN
Provider First Name:
KHALID
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HASAN
Provider Other First Name:
SY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417919085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25078 PEACHLAND AVE STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWHALL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91321-2558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-253-4420
Provider Business Mailing Address Fax Number:
661-253-4425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25078 PEACHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEWHALL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-821-2883
Provider Business Practice Location Address Fax Number:
480-237-5799
Provider Enumeration Date:
04/06/2006

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: 207RE0101X , with the licence number:  C134457 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0205X , with the licence number: C134457 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 147208 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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