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General NPI Number Information
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NPI Number | 1376041962
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Entity Type | Organization
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Legal Business Name | AMERICAN ADVANCED GASTROENTEROLOGY INC
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 173 E WEBSTER ST
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City | COLUSA
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State | CA
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Zip | 95932-2949
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Country | US
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Telephone | 209-857-4787
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Fax | 209-248-7856
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Provider Business Mailing Address
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Address Line | 4120 DALE RD # J8-140
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City | MODESTO
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State | CA
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Zip | 95356-9232
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Country | US
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Telephone | 209-857-4787
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Fax | 209-248-7856
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOHAMMAD HUMAYOUN KHAN
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Credential | MD
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Telephone | 312-224-8764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A35408
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License Number State | CA
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