Healthcare Provider Details

I. General information

NPI: 1326289737
Provider Name (Legal Business Name): SADEEQ KHAN SADIQ, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 PALM AVE
IMPERIAL BEACH CA
91932-1529
US

IV. Provider business mailing address

888 PALM AVE
IMPERIAL BEACH CA
91932-1529
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 Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA89200
License Number StateCA

VIII. Authorized Official

Name: DR. SADEEQ KHAN SADIQ
Title or Position: DIRECTOR
Credential: M.D.
Phone: 619-423-0100