Provider Demographics
NPI:1285061986
Name:KHAN, TAHIR (DDS)
Entity type:Individual
Prefix:DR
First Name:TAHIR
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 ORANGE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-8128
Mailing Address - Country:US
Mailing Address - Phone:714-369-5267
Mailing Address - Fax:
Practice Address - Street 1:305 ORANGE AVE STE D
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-8128
Practice Address - Country:US
Practice Address - Phone:714-369-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-26
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist