Provider Demographics
NPI:1730355801
Name:FULLERTON CHEST AND CRTITICAL CARE INC
Entity type:Organization
Organization Name:FULLERTON CHEST AND CRTITICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FARHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHABAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-447-7303
Mailing Address - Street 1:1038 E BASTANCHURY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2786
Mailing Address - Country:US
Mailing Address - Phone:714-447-7303
Mailing Address - Fax:714-996-9267
Practice Address - Street 1:1038 E BASTANCHURY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2786
Practice Address - Country:US
Practice Address - Phone:714-447-7303
Practice Address - Fax:714-996-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69690207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427159458OtherINDIVIDUAL NPI