Healthcare Provider Details

I. General information

NPI: 1730530494
Provider Name (Legal Business Name): KHEITER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 JACKSON ST
RIVERSIDE CA
92503
US

IV. Provider business mailing address

1941 CALIFORNIA AVE
CORONA CA
92877-0200
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-2211
  • Fax:
Mailing address:
  • Phone: 360-713-3358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AHMED KHEITER
Title or Position: PRESIDENT
Credential: MD
Phone: 360-713-3358