Basic Information
| Provider Information | |||||||||
| NPI: | 1306396320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FARHAN KHABAZ MD PROFESSIONAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15642 SAND CANYON AVE | ||||||||
| Address2: | # 54508 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926195478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147728282 | ||||||||
| FaxNumber: | 7147726493 | ||||||||
| Practice Location | |||||||||
| Address1: | 15642 SAND CANYON AVE | ||||||||
| Address2: | # 54508 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926195478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147728282 | ||||||||
| FaxNumber: | 7147726493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2016 | ||||||||
| LastUpdateDate: | 10/17/2017 | ||||||||
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| AuthorizedOfficialLastName: | KHABAZ | ||||||||
| AuthorizedOfficialFirstName: | FARHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7144475106 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | A69690 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.