MEDICARE: KHALID B. KHAN M.D., INC

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	207Q00000X	Family Medicine Physician	A62486	CA

General Provider Information

NPI Number	:	1750327235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHALID B. KHAN M.D., INC

Provider Business Mailing Address
First Line	:	13425 INGLEWOOD AVE
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5608
Country	:	US
Telephone Number	:	310-679-2201
Fax Number	:	310-679-4236

Provider Business Practice Location Address
First Line	:	13425 INGLEWOOD AVE
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-5608
Country	:	US
Telephone Number	:	310-679-2201
Fax Number	:	310-679-4236

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KHALID B KHAN
Credential	:	M.D.
Telephone Number	:	310-679-2201

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	12/14/2012

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