Healthcare Provider Details

I. General information

NPI: 1770822645
Provider Name (Legal Business Name): HYDE PARK MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13950 MILTON AVE SUITE 404
WESTMINSTER CA
92683-2900
US

IV. Provider business mailing address

6011 PACIFIC BLVD SUITE 116
HUNTINGTON PARK CA
90255-2951
US

V. Phone/Fax

Practice location:
  • Phone: 714-568-1100
  • Fax: 714-568-1101
Mailing address:
  • Phone: 714-568-1100
  • Fax: 714-568-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA62362
License Number StateCA

VIII. Authorized Official

Name: DR. RAHIL RASHID KHAN
Title or Position: OWNER
Credential: M.D.
Phone: 310-877-5692