Individual provider Active NPI

Adrian J Khaw, MD

  • Pediatrics Physician
  • Truckee, CA
National Provider Identifier
1144268863
Registry record updated Nov 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD469282 Issued in PA
Practice address
10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234
Phone
(415) 424-4266
Fax
(415) 520-6633
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2022

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 38125 OK
Pediatrics Physician 208000000X D95231 MD
Pediatrics Physician 208000000X T0257 TX
Pediatrics Physician 208000000X 258789 NY
Pediatrics Physician 208000000X 68680 MN
Pediatrics Physician 208000000X ME147496 FL
Pediatrics Physician 208000000X 2021014516 MO
Pediatrics Physician 208000000X 20680 NV
Pediatrics Physician 208000000X DR.0065494 CO
Pediatrics Physician 208000000X 88333 GA
Pediatrics Physician 208000000X 036154818 IL
Pediatrics Physician 208000000X ME95394 FL
Pediatrics Physician 208000000X 286231 MA
Pediatrics Physician 208000000X C170906 CA
Pediatrics Physician 208000000X MD469282 PA Primary

Addresses

Primary practice location

10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234

Mailing address

10775 Pioneer TRL Ste 215
Truckee, CA 96161-0234
Phone (415) 424-4266

Other identifiers 7

IdentifierTypeStateIssuer
830095309MedicaidMO
110568800MedicaidFL
1144268863MedicaidIL
250012079MedicaidNV
9000187587MedicaidCO
100199977MedicaidCA
423421301MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110127000713 NY Practitioner - Pediatric Medicine 3678677317 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C170906CAMDPediatrics Physician
DR.0065494COMDPediatrics Physician
ME147496FLMDPediatrics Physician
88333GAMDPediatrics Physician
036154818ILMDPediatrics Physician
286231MAMDPediatrics Physician
D95231MDMDPediatrics Physician
68680MNMDPediatrics Physician
2021014516MOMDPediatrics Physician
20680NVMDPediatrics Physician
38125OKMDPediatrics Physician
MD469282PAMDPediatrics Physician
T0257TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sun River Health Inc. CurrentSince May 1, 2019 Accepting new patients
Sun River Health Inc Current Accepting new patients
Telehealth Services USA Pediatrics Past Accepting new patients

Locations

3360 Route 343
Amenia, NY 12501
Phone (845) 373-9006

803 Sterling Pl
Brooklyn, NY 11216
Phone (718) 613-1700

10504 Sutphin Blvd
Jamaica, NY 11435
Phone (718) 725-5000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667520000000",
    "number": "1144268863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10775 PIONEER TRL STE 215",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610234",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10775 PIONEER TRL STE 215",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961610234",
            "telephone_number": "415-424-4266",
            "fax_number": "415-520-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAW",
        "first_name": "ADRIAN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2022-11-04",
        "certification_date": "2022-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OK",
            "license": "38125",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D95231",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "T0257",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "258789",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "68680",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME147496",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2021014516",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NV",
            "license": "20680",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "DR.0065494",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "88333",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036154818",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME95394",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "286231",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C170906",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD469282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "830095309",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110568800",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1144268863",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250012079",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000187587",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100199977",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "423421301",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Truckee, CA

Sources for this page

Verify at the official NPI Registry.