Healthcare Provider Details

I. General information

NPI: 1083470900
Provider Name (Legal Business Name): KHAN ANESTHESIA CRITICAL CARE AND PAIN MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JAMBOREE RD STE 1200
NEWPORT BEACH CA
92660-2904
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 949-988-7888
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALIA KATTAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-792-3914