Healthcare Provider Details

I. General information

NPI: 1417111766
Provider Name (Legal Business Name): NAVEED ABAS KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 02/10/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W CARROLL AVE STE 202
GLENDORA CA
91741-4208
US

IV. Provider business mailing address

PO BOX 4039
ORANGE CA
92863-4039
US

V. Phone/Fax

Practice location:
  • Phone: 626-225-2111
  • Fax:
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC159086
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD.203063
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC159086
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number018735
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: