Provider Demographics
NPI:1992576672
Name:SAPPHIRE HEALTHCARE MEDICAL GROUP INC
Entity type:Organization
Organization Name:SAPPHIRE HEALTHCARE MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABDUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-219-4903
Mailing Address - Street 1:11689 THE PLZ
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3930
Mailing Address - Country:US
Mailing Address - Phone:562-219-4903
Mailing Address - Fax:562-219-4904
Practice Address - Street 1:11689 THE PLZ
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3930
Practice Address - Country:US
Practice Address - Phone:562-219-4903
Practice Address - Fax:562-219-4904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty