Healthcare Provider Details

I. General information

NPI: 1659772622
Provider Name (Legal Business Name): MOHAMMAD HASSAN KHAZAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LINCOLN RD UNIT 1221
MIAMI BEACH FL
33139-2013
US

IV. Provider business mailing address

100 LINCOLN RD UNIT 1221
MIAMI BEACH FL
33139-2013
US

V. Phone/Fax

Practice location:
  • Phone: 310-701-5408
  • Fax:
Mailing address:
  • Phone: 310-701-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME 120423
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 120423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: