Provider Demographics
NPI:1609091818
Name:KHAN, HUMAYON YOUSUF (MD)
Entity Type:Individual
Prefix:
First Name:HUMAYON
Middle Name:YOUSUF
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H. JOSEPH
Other - Middle Name:YOUSUF
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1629 W 17TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3335
Mailing Address - Country:US
Mailing Address - Phone:714-972-2111
Mailing Address - Fax:714-972-2045
Practice Address - Street 1:1629 W 17TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3335
Practice Address - Country:US
Practice Address - Phone:714-972-2111
Practice Address - Fax:714-972-2045
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74748207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G747480Medicaid
CA00G747480Medicaid