Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A12642 | CA |
NPI | 1205262466 |
---|---|
Provider Name | Sana Khan |
First Address | Chino, CA 91710 |
Second Address | Chino, CA 91710-4179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2013 |
Last Update Date | 19/09/2013 |