Provider Demographics
NPI:1205927902
Name:KHAN, SALMA H (M D)
Entity type:Individual
Prefix:DR
First Name:SALMA
Middle Name:H
Last Name:KHAN
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 BARRANCA PARKWAY SUITE #201
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-9998
Mailing Address - Country:US
Mailing Address - Phone:949-249-1550
Mailing Address - Fax:949-679-9450
Practice Address - Street 1:4950 BARRANCA PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4671
Practice Address - Country:US
Practice Address - Phone:949-294-1550
Practice Address - Fax:949-653-6192
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA647112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9592794OtherCIGNA PROVIDER # - CORONA
CA00A647110Medicaid
CA7682011OtherAETNA - CORONA
CA00A647110OtherBLUE SHIELD - CORONA
FLCQ498ZMedicare PIN
CA00A647110Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA00A647110Medicaid