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General NPI Number Information
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NPI Number | 1629308135
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Entity Type | Individual
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Provider Name | OMAR AHMED KHAN DNP, APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 323 N PRAIRIE AVE
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City | INGLEWOOD
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State | CA
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Zip | 90301-4502
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Country | US
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Telephone | 310-846-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 4760 SEPULVEDA BLVD
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City | CULVER CITY
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State | CA
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Zip | 90230-4820
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Country | US
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Telephone | 310-390-6612
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Fax | 310-398-5690
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 851513
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0995819-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95008495
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License Number State | CA
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