Provider Demographics
NPI:1427374149
Name:KHAN, SOBIYA (DO)
Entity type:Individual
Prefix:DR
First Name:SOBIYA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18041 RAYMER ST
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3161
Mailing Address - Country:US
Mailing Address - Phone:917-656-9767
Mailing Address - Fax:
Practice Address - Street 1:390 N PACIFIC COAST HWY STE 3000
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4486
Practice Address - Country:US
Practice Address - Phone:917-656-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08746000207P00000X
CA12093207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine