Provider Demographics
NPI:1649274150
Name:KHAN, DAVID CHIA-ONT (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHIA-ONT
Last Name:KHAN
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 1:860 PARKVIEW DRIVE NORTH
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4914
Mailing Address - Country:US
Mailing Address - Phone:310-414-9990
Mailing Address - Fax:310-943-2703
Practice Address - Street 1:860 PARKVIEW DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4914
Practice Address - Country:US
Practice Address - Phone:310-414-9990
Practice Address - Fax:310-943-2703
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA657742085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A657740Medicaid
WA65774A,B,C,D,E,FMedicare ID - Type Unspecified
CA00A657740Medicaid