NPIMap

Individual provider Active NPI

Abdul Rab Khan, MD

  • General Practice Physician
  • Los Angeles, CA
National Provider Identifier
1063400380
Registry record updated Jul 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A53877 Issued in CA
Practice address
2105 Beverly Blvd
Suite 231
Los Angeles, CA 90057-2216
Phone
(213) 483-8400
Fax
(213) 483-8445
NPI assigned
Oct 11, 2005
Last updated
Jul 21, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A53877 CA Primary

Addresses

Primary practice location

2105 Beverly Blvd
Suite 231
Los Angeles, CA 90057-2216

Mailing address

2105 Beverly Blvd
Suite 231
Los Angeles, CA 90057-2216
Phone (213) 483-8400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

8619 Reseda Blvd
Suite 201
Northridge, CA 91324-4042

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1242
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A53877CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medix Wound Care Physicians Inc CurrentSince Jul 1, 2023 Accepting new patients
Divine Help Medical Group Inc General Practice CurrentSince Apr 1, 2019 Accepting new patients
Medco Healthcare Medical Group Inc CurrentSince Apr 1, 2022 Accepting new patients

Locations

177 Business Center Dr
Corona, CA 92878
Phone (951) 268-9245

355 E Rincon St
Ste 217
Corona, CA 92879
Phone (714) 829-7026

355 E Rincon St
Ste 215
Corona, CA 92879
Phone (951) 268-9245

1500 S Central Ave
Ste 320
Glendale, CA 91204
Phone (818) 396-5670

1711 W Temple St
Ste 5613
Los Angeles, CA 90026
Phone (213) 483-8400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279670400000",
    "number": "1063400380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "address_2": "SUITE 231",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-483-8400",
            "fax_number": "213-483-8445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 BEVERLY BLVD",
            "address_2": "SUITE 231",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900572216",
            "telephone_number": "213-483-8400",
            "fax_number": "213-483-8445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "ABDUL",
        "middle_name": "RAB",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2010-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A53877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.