Provider Demographics
NPI:1013132901
Name:ZAFAR S KHAN M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ZAFAR S KHAN M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAFAR
Authorized Official - Middle Name:SALEEM
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-850-7300
Mailing Address - Street 1:11160 WARNER AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4008
Mailing Address - Country:US
Mailing Address - Phone:714-850-7300
Mailing Address - Fax:714-850-7310
Practice Address - Street 1:11160 WARNER AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4008
Practice Address - Country:US
Practice Address - Phone:714-850-7300
Practice Address - Fax:714-850-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85906208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85906OtherMEDICAL LICENSE
CAH91939Medicare UPIN
CAW18059Medicare PIN