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General NPI Number Information
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NPI Number | 1780993360
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Entity Type | Organization
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Legal Business Name | MOHD QAISAR A KHAN MD INC
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Dates
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Enumeration Date | 09/30/2010
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Last Update Date | 09/30/2010
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Provider Practice Location Address
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Address Line | 1535 W MERCED AVE STE 302
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City | WEST COVINA
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State | CA
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Zip | 91790-3404
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Country | US
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Telephone | 626-918-4566
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 W MERCED AVE STE 302
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City | WEST COVINA
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State | CA
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Zip | 91790-3404
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Country | US
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Telephone | 626-918-4566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MOHD QAISAR A KHAN
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Credential | M.D.
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Telephone | 626-918-4566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A31322
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License Number State | CA
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