Provider Demographics
NPI:1588845457
Name:IFTIKHAR A. KHAN M.D., INC.
Entity Type:Organization
Organization Name:IFTIKHAR A. KHAN M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOOR
Authorized Official - Middle Name:ZUBEIDA
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-725-3099
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:SUITE # 406
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4300
Mailing Address - Country:US
Mailing Address - Phone:323-725-3099
Mailing Address - Fax:323-725-2998
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE # 406
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-725-3099
Practice Address - Fax:323-725-2998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A368241Medicaid
CAW21643Medicare PIN
CA00A368241Medicaid
CAA36824Medicare Oscar/Certification