=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083836803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAHIL KHAN MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 03/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8349 RESEDA BLVD
-----------------------------------------------------
City | NORTHRIDGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91324-4622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-280-6816
-----------------------------------------------------
Fax | 818-280-6859
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7521 EDINGER AVE 4308
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92647-3508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-362-4921
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RAHIL RASHID KHAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-362-4921
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | A62362
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------