Provider Demographics
NPI:1922087394
Name:KHAGHANI, AYOUB (MD)
Entity Type:Individual
Prefix:
First Name:AYOUB
Middle Name:
Last Name:KHAGHANI
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 1:1724 PORT ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5334
Mailing Address - Country:US
Mailing Address - Phone:714-662-1515
Mailing Address - Fax:
Practice Address - Street 1:1724 PORT ASHLEY PL
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5334
Practice Address - Country:US
Practice Address - Phone:714-662-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A446180Medicaid
CAE69150Medicare UPIN