Basic Information
| Provider Information | |||||||||
| NPI: | 1952542169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | FARAZ | ||||||||
| MiddleName: | ALI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11370 ANDERSON ST STE 2100 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923543450 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 11370 ANDERSON ST STE 2100 | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095582822 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2009 | ||||||||
| LastUpdateDate: | 08/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | A156443 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0120X | A156443 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 208600000X | 4301092787 | MI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | A156443 | CA | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.