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General NPI Number Information
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NPI Number | 1174625404
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Entity Type | Individual
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Provider Name | MILLY PERVEEN KHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/08/2016
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Provider Practice Location Address
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Address Line | 1776 E CENTURY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90002-3050
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Country | US
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Telephone | 323-374-6848
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Fax | 323-889-7821
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Provider Business Mailing Address
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Address Line | 1776 E CENTURY BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90002-3050
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Country | US
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Telephone | 323-374-6848
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Fax | 323-889-7821
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C141332
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License Number State | CA
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