Healthcare Provider Details

I. General information

NPI: 1417919085
Provider Name (Legal Business Name): KHALID S HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SY HASAN M.D.

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25078 PEACHLAND AVE SUITE A
NEWHALL CA
91321
US

IV. Provider business mailing address

25078 PEACHLAND AVE STE A
NEWHALL CA
91321-2558
US

V. Phone/Fax

Practice location:
  • Phone: 480-821-2883
  • Fax: 480-237-5799
Mailing address:
  • Phone: 661-253-4420
  • Fax: 661-253-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberC134457
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberC134457
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: