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General NPI Number Information
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NPI Number | 1700016854
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Entity Type | Individual
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Provider Name | WAQAS AHMAD KHAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 12/14/2015
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Provider Practice Location Address
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Address Line | 2101 N WATERMAN AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4836
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Country | US
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Telephone | 909-881-4520
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Fax | 909-881-4526
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Provider Business Mailing Address
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Address Line | 5410 MARYLAND WAY SUITE 300
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City | BRENTWOOD
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State | TN
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Zip | 37027-5064
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Country | US
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Telephone | 615-377-5600
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Fax | 949-567-9827
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A 108929
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | A 108929
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036133312
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License Number State | IL
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