Provider Demographics
NPI:1538370861
Name:KHAN, IRFAN ALI (MD)
Entity type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 ROSCOE BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5600
Mailing Address - Country:US
Mailing Address - Phone:747-202-0132
Mailing Address - Fax:818-885-5497
Practice Address - Street 1:18350 ROSCOE BLVD STE 700
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5600
Practice Address - Country:US
Practice Address - Phone:747-202-0132
Practice Address - Fax:818-885-5497
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND10444207RC0200X, 207RP1001X
CAA85387207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538370861Medicaid
CAGW794ZMedicare PIN