Provider Demographics
NPI:1023272309
Name:HASSAN, KHALED MAHMOUD (MD)
Entity type:Individual
Prefix:
First Name:KHALED
Middle Name:MAHMOUD
Last Name:HASSAN
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 1:2720 N HARBOR BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2609
Mailing Address - Country:US
Mailing Address - Phone:714-578-8527
Mailing Address - Fax:714-578-8570
Practice Address - Street 1:2720 N HARBOR BLVD
Practice Address - Street 2:STE 220
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2609
Practice Address - Country:US
Practice Address - Phone:714-578-8527
Practice Address - Fax:714-578-8570
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111137207NS0135X, 207ND0101X, 207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology