Provider Demographics
NPI:1992886337
Name:KHAN, TALAT AFSANA (MD)
Entity type:Individual
Prefix:
First Name:TALAT
Middle Name:AFSANA
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3118
Mailing Address - Country:US
Mailing Address - Phone:951-340-2178
Mailing Address - Fax:951-340-2178
Practice Address - Street 1:703 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3118
Practice Address - Country:US
Practice Address - Phone:951-340-2178
Practice Address - Fax:951-340-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A687360Medicaid
CA00A687360Medicaid
CAH21160Medicare UPIN