Healthcare Provider Details

I. General information

NPI: 1831753524
Provider Name (Legal Business Name): RAFAE KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2019
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADULT MEDICAL CARE CLINIC TWENTYNINE PALMS 1546 6TH ST
TWENTYNINE PALMS CA
92277
US

IV. Provider business mailing address

ADULT MEDICAL CARE CLINIC TWENTYNINE PALMS 1546 6TH ST
TWENTYNINE PALMS CA
92277
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270466
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: