Provider Demographics
NPI:1144268863
Name:KHAW, ADRIAN J (MD)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:J
Last Name:KHAW
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 1:10775 PIONEER TRL STE 215
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0234
Mailing Address - Country:US
Mailing Address - Phone:415-424-4266
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:415-520-6633
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38125208000000X
MDD95231208000000X
TXT0257208000000X
NY258789208000000X
MN68680208000000X
FLME147496208000000X
MO2021014516208000000X
NV20680208000000X
CODR.0065494208000000X
GA88333208000000X
IL036154818208000000X
FLME95394208000000X
MA286231208000000X
CAC170906208000000X
PAMD469282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO830095309Medicaid
FL110568800Medicaid
IL1144268863Medicaid
NV250012079Medicaid
CO9000187587Medicaid
CA100199977Medicaid
TX423421301Medicaid