Healthcare Provider Details

I. General information

NPI: 1477753903
Provider Name (Legal Business Name): NAWAZISH ALI KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2671
US

IV. Provider business mailing address

14200 W CELEBRATE LIFE WAY
GOODYEAR AZ
85338-3007
US

V. Phone/Fax

Practice location:
  • Phone: 562-735-3226
  • Fax: 833-438-9659
Mailing address:
  • Phone: 623-207-3000
  • Fax: 623-207-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number50725
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101245627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: