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Individual

KHALIQ SIDDIQ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
279 IMPERIAL HWY, SUITE 770, FULLERTON, CA 92835-1041
(714) 449-4803
Mailing address
279 IMPERIAL HWY, SUITE 770, FULLERTON, CA 92835-1041
(714) 449-4803

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A79864
CA
208M00000X
Hospitalist Physician
Primary
A79864
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00A798640
MEDI- CAL
CA
Enumeration date
08/03/2005
Last updated
05/02/2012
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