Provider Demographics
NPI:1629790639
Name:KHAN, JAMIL AHMED
Entity Type:Individual
Prefix:
First Name:JAMIL
Middle Name:AHMED
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16601 YUKON AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1314
Mailing Address - Country:US
Mailing Address - Phone:310-972-0011
Mailing Address - Fax:
Practice Address - Street 1:16601 YUKON AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1314
Practice Address - Country:US
Practice Address - Phone:310-972-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies