Provider Demographics
NPI:1811217037
Name:KHANIFAR, ELHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:KHANIFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 ATLANTIC AVE
Mailing Address - Street 2:LBMMC DEPARTMENT OF PATHOLOGY
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1701
Mailing Address - Country:US
Mailing Address - Phone:562-933-0717
Mailing Address - Fax:562-933-0791
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:LBMMC DEPARTMENT OF PATHOLOGY
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-0717
Practice Address - Fax:562-933-0791
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA106655207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGX865ZMedicare PIN