Basic Information
| Provider Information | |||||||||
| NPI: | 1306239165 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NAUSHAD A KHERAJ, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25050 AVENUE KEARNY | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614300940 | ||||||||
| FaxNumber: | 6612950862 | ||||||||
| Practice Location | |||||||||
| Address1: | 3580 SANTA ANITA AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262031596 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2015 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | KHERAJ | ||||||||
| AuthorizedOfficialFirstName: | NAUSHAD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 6262031596 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | A38084 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | A38084 | 01 | CA | MEDICAL STATE LICENSE | OTHER |