Provider Demographics
NPI:1508516766
Name:MAHMOOD, KHALID
Entity type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:MAHMOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9442 N ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 BUTTE ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0852
Practice Address - Country:US
Practice Address - Phone:530-244-5400
Practice Address - Fax:530-244-5436
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA198732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine