Provider Demographics
NPI:1750330932
Name:KHAN, ANDREW S (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:KHAN
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:PO BOX 660519
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-0519
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:15248 11TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3704
Practice Address - Country:US
Practice Address - Phone:760-245-8691
Practice Address - Fax:760-843-6020
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6501207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX65010Medicaid
CA020A65013Medicare PIN
CAH20A6501AMedicare PIN
CAG35891Medicare UPIN
CAAQ317VMedicare PIN
CAW20A6501GMedicare PIN