Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A154905 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | A154905 | CA |
NPI | 1003115619 |
---|---|
Provider Name | Jawad Khan |
First Address | Fountain Valley, CA 92708-4045 |
Second Address | Fountain Valley, CA 92708-4045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2011 |
Last Update Date | 22/06/2020 |