Healthcare Provider Details

I. General information

NPI: 1851553424
Provider Name (Legal Business Name): JAVAID M. KHAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4500
  • Fax:
Mailing address:
  • Phone: 559-436-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberOS11890
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberOS11890
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS11890
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number20A13876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: