Healthcare Provider Details

I. General information

NPI: 1477754612
Provider Name (Legal Business Name): ALIUDDIN M KHAJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 MAGNOLIA AVE STE 2F
CORONA CA
92879-3122
US

IV. Provider business mailing address

770 MAGNOLIA AVE STE 2F
CORONA CA
92879-3122
US

V. Phone/Fax

Practice location:
  • Phone: 805-952-3517
  • Fax: 951-356-5494
Mailing address:
  • Phone: 805-952-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA92186
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberA92186
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA 92186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: