Healthcare Provider Details

I. General information

NPI: 1902954837
Provider Name (Legal Business Name): AHMAD SADOON KHALIFA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PACIFIC AVE
LONG BEACH CA
90813-4225
US

IV. Provider business mailing address

5540 SPINNAKER BAY DR
LONG BEACH CA
90803-6804
US

V. Phone/Fax

Practice location:
  • Phone: 562-546-2496
  • Fax: 562-546-2794
Mailing address:
  • Phone: 562-644-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA79995
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA79995
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA79995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: