Healthcare Provider Details

I. General information

NPI: 1861029951
Provider Name (Legal Business Name): ISMAIL SOHAIL KHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12821 MEDITERRANEAN DR
RANCHO CUCAMONGA CA
91739-8954
US

IV. Provider business mailing address

12821 MEDITERRANEAN DR
RANCHO CUCAMONGA CA
91739-8954
US

V. Phone/Fax

Practice location:
  • Phone: 800-872-2273
  • Fax:
Mailing address:
  • Phone: 909-684-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number328114-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A23700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: