Healthcare Provider Details

I. General information

NPI: 1174605133
Provider Name (Legal Business Name): SAMINA KHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N PROSPECT AVE STE 103
REDONDO BEACH CA
90277-3041
US

IV. Provider business mailing address

520 N PROSPECT AVE STE 103
REDONDO BEACH CA
90277-3041
US

V. Phone/Fax

Practice location:
  • Phone: 310-376-8816
  • Fax: 310-374-2806
Mailing address:
  • Phone: 310-376-8816
  • Fax: 310-374-2806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12062
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC52731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: