Healthcare Provider Details

I. General information

NPI: 1881642205
Provider Name (Legal Business Name): SADEEQ KHAN SADIQ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PALM AVE SUITE 108A
IMPERIAL BEACH CA
91932-1200
US

IV. Provider business mailing address

600 PALM AVE SUITE 108A
IMPERIAL BEACH CA
91932-1200
US

V. Phone/Fax

Practice location:
  • Phone: 619-423-0100
  • Fax: 619-423-0120
Mailing address:
  • Phone: 619-423-0100
  • Fax: 619-423-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA89200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: