Healthcare Provider Details

I. General information

NPI: 1811825086
Provider Name (Legal Business Name): HEBAH KHAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 E 6TH ST APT 104
CORONA CA
92879-1621
US

IV. Provider business mailing address

1044 E 6TH ST APT 104
CORONA CA
92879-1621
US

V. Phone/Fax

Practice location:
  • Phone: 309-750-4151
  • Fax: 309-750-4151
Mailing address:
  • Phone: 309-750-4151
  • Fax: 309-750-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: