Provider Demographics
NPI:1285687350
Name:KHAN, ALIYA I (MD)
Entity Type:Individual
Prefix:
First Name:ALIYA
Middle Name:I
Last Name:KHAN
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 1:4060 FAIRMOUNT AVE
Mailing Address - Street 2:OBGYN DEPARTMENT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1608
Mailing Address - Country:US
Mailing Address - Phone:619-280-7072
Mailing Address - Fax:619-961-0804
Practice Address - Street 1:1032 BROADWAY
Practice Address - Street 2:OB-GYN
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021
Practice Address - Country:US
Practice Address - Phone:619-795-5991
Practice Address - Fax:619-795-5992
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650634207V00000X
CAG50634207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006506340Medicaid
CA006506340Medicaid
A92994Medicare UPIN