MEDICARE: MISS NAZIRAH K KHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A51274	CA

General Provider Information

NPI Number	:	1720188253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NAZIRAH K KHAN

Provider Business Mailing Address
First Line	:	5650 JILLSON ST
Second Line	:
City	:	COMMERCE
State	:	CA
Zip	:	90040-1482
Country	:	US
Telephone Number	:	323-201-4516
Fax Number	:

Provider Business Practice Location Address
First Line	:	3591 E IMPERIAL HWY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-2654
Country	:	US
Telephone Number	:	562-867-7999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	02/05/2021

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