Provider Demographics
NPI:1467617159
Name:KHAN, AYAZ O (DO)
Entity Type:Individual
Prefix:DR
First Name:AYAZ
Middle Name:O
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 CALLE FRANCESCA
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4457
Mailing Address - Country:US
Mailing Address - Phone:626-376-8463
Mailing Address - Fax:
Practice Address - Street 1:648 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3621
Practice Address - Country:US
Practice Address - Phone:909-927-8487
Practice Address - Fax:844-431-4730
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9417204D00000X, 208D00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice