Provider Demographics
NPI:1114095098
Name:KHAN, IFTIKHAR ABRAR (M D)
Entity type:Individual
Prefix:
First Name:IFTIKHAR
Middle Name:ABRAR
Last Name:KHAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:SUITE # 406
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4300
Mailing Address - Country:US
Mailing Address - Phone:323-725-3099
Mailing Address - Fax:323-725-2998
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE # 406
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-725-3099
Practice Address - Fax:323-725-2998
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 36824207R00000X, 207RC0000X, 207RC0200X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A368241Medicaid
CAA 28190Medicare UPIN
CA00A368241Medicaid
CAA36824Medicare Oscar/Certification