Provider Demographics
NPI:1902954837
Name:KHALIFA, AHMAD SADOON (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:SADOON
Last Name:KHALIFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5540 SPINNAKER BAY DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-6804
Mailing Address - Country:US
Mailing Address - Phone:562-644-9293
Mailing Address - Fax:
Practice Address - Street 1:5540 SPINNAKER BAY DR
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-6804
Practice Address - Country:US
Practice Address - Phone:562-644-9293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79995207RG0300X, 207V00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABK8616231OtherDEA NUMBER
CABK8616231OtherDEA NUMBER
00A799950Medicare PIN