Healthcare Provider Details

I. General information

NPI: 1992576672
Provider Name (Legal Business Name): SAPPHIRE HEALTHCARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11689 THE PLZ
NORWALK CA
90650-3930
US

IV. Provider business mailing address

11689 THE PLZ
NORWALK CA
90650-3930
US

V. Phone/Fax

Practice location:
  • Phone: 562-219-4903
  • Fax: 562-219-4904
Mailing address:
  • Phone: 562-219-4903
  • Fax: 562-219-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: ABDUL KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 562-219-4903