Healthcare Provider Details

I. General information

NPI: 1477020246
Provider Name (Legal Business Name): AHAD U. KHAN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVE.
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

11420 WARNER AVE.
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1300
  • Fax: 714-433-3100
Mailing address:
  • Phone: 714-549-1300
  • Fax: 714-433-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013514
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: