Provider Demographics
NPI:1023235926
Name:LANG, L KHADIJAH (MD)
Entity type:Individual
Prefix:DR
First Name:L
Middle Name:KHADIJAH
Last Name:LANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1651
Mailing Address - Country:US
Mailing Address - Phone:323-292-3900
Mailing Address - Fax:323-295-2117
Practice Address - Street 1:4361 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1651
Practice Address - Country:US
Practice Address - Phone:323-292-3900
Practice Address - Fax:323-295-2117
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G665030Medicaid
CA00G665030Medicaid
CAF73482Medicare UPIN