Provider Demographics
NPI:1780608638
Name:ALI-KHAN, MIR IFTEKHAR (MD,)
Entity type:Individual
Prefix:
First Name:MIR
Middle Name:IFTEKHAR
Last Name:ALI-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 1:2058 MILLS AVE
Mailing Address - Street 2:PO BOX 350
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:818-845-3510
Mailing Address - Fax:818-845-0528
Practice Address - Street 1:2900 E DEL MAR BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4375
Practice Address - Country:US
Practice Address - Phone:626-795-9901
Practice Address - Fax:818-845-0528
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA488272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48827CMedicare ID - Type Unspecified
CAA78732Medicare UPIN