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General NPI Number Information
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NPI Number | 1558720516
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Entity Type | Organization
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Legal Business Name | AYAZ O KHAN INC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 648 N PARK AVE
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City | POMONA
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State | CA
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Zip | 91768-3621
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Country | US
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Telephone | 909-927-8487
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Fax | 844-431-4730
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Provider Business Mailing Address
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Address Line | 2035 CALLE FRANCESCA
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City | SAN DIMAS
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State | CA
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Zip | 91773-4457
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | AYAZ O KHAN
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Credential | DO
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Telephone | 626-376-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20A9417
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License Number State | CA
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