Provider Demographics
NPI:1639292758
Name:ZAFFARKHAN, KHYBER (DO)
Entity Type:Individual
Prefix:
First Name:KHYBER
Middle Name:
Last Name:ZAFFARKHAN
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 1:20341 SW BIRCH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1514
Mailing Address - Country:US
Mailing Address - Phone:949-438-1888
Mailing Address - Fax:949-200-6909
Practice Address - Street 1:20341 SW BIRCH ST STE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1514
Practice Address - Country:US
Practice Address - Phone:949-438-1888
Practice Address - Fax:949-200-6909
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA231672208100000X
CA20A9973208100000X, 208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9973OtherCA LICENSE