Healthcare Provider Details

I. General information

NPI: 1164752168
Provider Name (Legal Business Name): ALBERT KHAIT M.D,.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CABOT DR STE 145
CORONA CA
92883-7384
US

IV. Provider business mailing address

2780 CABOT DR STE 145
CORONA CA
92883-7384
US

V. Phone/Fax

Practice location:
  • Phone: 909-206-4387
  • Fax:
Mailing address:
  • Phone: 909-206-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA110479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: