Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 54611 | CA |
NPI | 1063668671 |
---|---|
Provider Name | Dr. Shehzad Khan |
First Address | Irvine, CA 92602-1645 |
Second Address | Irvine, CA 92602-1645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2008 |
Last Update Date | 14/08/2008 |