Provider Demographics
NPI:1992904395
Name:KHAN, HAMMAD
Entity type:Individual
Prefix:
First Name:HAMMAD
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:813-418-2313
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:813-418-2313
Practice Address - Fax:909-946-8700
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92889207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB225164Medicare PIN
CACA117098Medicare PIN