Healthcare Provider Details

I. General information

NPI: 1922008143
Provider Name (Legal Business Name): MOHAMMAD A KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10694 MAGNOLIA AVE
RIVERSIDE CA
92505-1816
US

IV. Provider business mailing address

10694 MAGNOLIA AVE
RIVERSIDE CA
92505-1816
US

V. Phone/Fax

Practice location:
  • Phone: 951-335-5461
  • Fax: 951-335-5267
Mailing address:
  • Phone: 951-335-5461
  • Fax: 951-335-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC137550
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036101678
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01057031A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC137550
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: