1710037346 NPI number — H. JOSEPH KHAN, M.D., INC.

Table of content: (NPI 1710037346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710037346 NPI number — H. JOSEPH KHAN, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H. JOSEPH KHAN, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARAMOUNT CARE MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710037346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1629 W 17TH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92706-3335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-972-2111
Provider Business Mailing Address Fax Number:
714-972-2045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12881 CHAPMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92840-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-663-2000
Provider Business Practice Location Address Fax Number:
714-663-9953
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
HUMAYON
Authorized Official Middle Name:
YOUSUF
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
714-972-2111

Provider Taxonomy Codes

  • Taxonomy code: 207VH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080H0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0087941 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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