Healthcare Provider Details

I. General information

NPI: 1295778215
Provider Name (Legal Business Name): MOHAMMAD NAEEMULLAH KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 WANKEL WAY STE A
OXNARD CA
93030-0191
US

IV. Provider business mailing address

525 N 18TH ST STE 601
PHOENIX AZ
85006-4101
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0521
  • Fax: 805-983-4186
Mailing address:
  • Phone: 602-307-9112
  • Fax: 602-307-9155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD2022-1353
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC0072
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1020342
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30038
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29905
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC-183205
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: