Healthcare Provider Details

I. General information

NPI: 1700274982
Provider Name (Legal Business Name): SOUTHERN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 LONG BEACH BLVD SUITE 100
LONG BEACH CA
90807-5407
US

IV. Provider business mailing address

4014 LONG BEACH BLVD SUITE 100
LONG BEACH CA
90807-5407
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-4900
  • Fax:
Mailing address:
  • Phone: 562-426-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA62362
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA62362
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA62362
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA62362
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA62362
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA62362
License Number StateCA

VIII. Authorized Official

Name: DR. RAHIL RASHID KHAN
Title or Position: OWNER
Credential: M.D.
Phone: 562-426-4900