Provider Demographics
NPI:1376708701
Name:KHAN, ANJUM HASAN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ANJUM
Middle Name:HASAN
Last Name:KHAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17221 MINNEHAHA ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6128
Mailing Address - Country:US
Mailing Address - Phone:818-366-7800
Mailing Address - Fax:
Practice Address - Street 1:17221 MINNEHAHA ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6128
Practice Address - Country:US
Practice Address - Phone:818-366-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics