Provider Demographics
NPI:1326039678
Name:KHAN, FAUZIA (MD)
Entity Type:Individual
Prefix:
First Name:FAUZIA
Middle Name:
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 1:135 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8513
Mailing Address - Country:US
Mailing Address - Phone:626-445-4310
Mailing Address - Fax:626-445-4583
Practice Address - Street 1:135 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-8513
Practice Address - Country:US
Practice Address - Phone:626-445-4310
Practice Address - Fax:626-445-4583
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A50190Medicaid
CA00A50190Medicaid
CAA50190Medicare ID - Type Unspecified