Healthcare Provider Details

I. General information

NPI: 1366592982
Provider Name (Legal Business Name): H JOSEPH KHAN M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W 17TH ST
SANTA ANA CA
92706-2718
US

IV. Provider business mailing address

111 W 17TH ST
SANTA ANA CA
92706-2718
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-2111
  • Fax: 714-972-2045
Mailing address:
  • Phone: 714-972-1111
  • Fax: 714-972-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HUMAYON YOUSUF KHAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 714-972-2111