1205927902 NPI number — DR. SALMA H. KHAN M D.

Table of content: DR. SALMA H. KHAN M D. (NPI 1205927902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205927902 NPI number — DR. SALMA H. KHAN M D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205927902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4950 BARRANCA PARKWAY SUITE #201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92604-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-249-1550
Provider Business Mailing Address Fax Number:
949-679-9450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4950 BARRANCA PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-4671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-294-1550
Provider Business Practice Location Address Fax Number:
949-653-6192
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  A64711 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9592794 . This is a "CIGNA PROVIDER # - CORONA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A647110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7682011 . This is a "AETNA - CORONA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A647110 . This is a "BLUE SHIELD - CORONA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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