Provider Demographics
NPI:1902954837
Name:KHALIFA, AHMAD SADOON (MD)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:SADOON
Last Name:KHALIFA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 SPINNAKER BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-6804
Mailing Address - Country:US
Mailing Address - Phone:562-644-9293
Mailing Address - Fax:
Practice Address - Street 1:801 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4225
Practice Address - Country:US
Practice Address - Phone:562-546-2496
Practice Address - Fax:562-546-2794
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79995207R00000X, 207RG0300X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK8616231OtherDEA NUMBER
CABK8616231OtherDEA NUMBER
00A799950Medicare PIN