Provider Demographics
NPI:1699827873
Name:ZAFAR-KHAN, FAWAD (MD)
Entity Type:Individual
Prefix:
First Name:FAWAD
Middle Name:
Last Name:ZAFAR-KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2878
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90294-2878
Mailing Address - Country:US
Mailing Address - Phone:310-829-0906
Mailing Address - Fax:310-449-1415
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 710E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2208
Practice Address - Country:US
Practice Address - Phone:310-829-0906
Practice Address - Fax:310-449-1415
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61984207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA61984Medicare ID - Type Unspecified
CAG16691Medicare UPIN