Provider Demographics
NPI:1568819431
Name:KHAN, USMAN ALI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:USMAN
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MC8893
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9000
Mailing Address - Country:US
Mailing Address - Phone:619-543-5540
Mailing Address - Fax:619-471-3931
Practice Address - Street 1:2125 ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1337
Practice Address - Country:US
Practice Address - Phone:310-582-7450
Practice Address - Fax:310-582-7495
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA155610207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program