=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477753903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAWAZISH ALI KHAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2007
-----------------------------------------------------
Last Update Date | 08/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18000 STUDEBAKER RD STE 800
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-2671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-735-3226
-----------------------------------------------------
Fax | 833-438-9659
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14200 W CELEBRATE LIFE WAY
-----------------------------------------------------
City | GOODYEAR
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85338-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-207-3000
-----------------------------------------------------
Fax | 623-207-3921
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 0101245627
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 50725
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------