Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A9417 | CA |
Y | 207W00000X | Ophthalmologist | 20A9417 | CA |
N | 208D00000X | General Practice Physician | 20A9417 | CA |
NPI | 1467617159 |
---|---|
Provider Name | Dr. Ayaz O Khan |
First Address | San Dimas, CA 91773-4457 |
Second Address | San Dimas, CA 91773-4457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2008 |
Last Update Date | 19/02/2015 |