Provider Demographics
NPI:1003115619
Name:KHAN, JAWAD (MD)
Entity Type:Individual
Prefix:
First Name:JAWAD
Middle Name:
Last Name:KHAN
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 1:11190 WARNER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4045
Mailing Address - Country:US
Mailing Address - Phone:714-241-7000
Mailing Address - Fax:714-241-7003
Practice Address - Street 1:11190 WARNER AVE STE 300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4045
Practice Address - Country:US
Practice Address - Phone:714-241-7000
Practice Address - Fax:714-241-7003
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA154905207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty