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NPI Code Detail

MEDICARE: DR. NAZIFAH KHAIRULLAH M.D.

MEDICARE: DR. NAZIFAH KHAIRULLAH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician25MA07450100NJ
2208000000XPediatrics PhysicianC142450CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659363562
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NAZIFAH KHAIRULLAH M.D.
Provider Business Mailing Address
First Line : 3054 HOPETON RD
Second Line :
City : LA CRESCENTA
State : CA
Zip : 91214-1324
Country : US
Telephone Number : 917-513-4340
Fax Number :
Provider Business Practice Location Address
First Line : 2055 LINCOLN AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1324
Country : US
Telephone Number : 626-488-8728
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 12/27/2016

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