Provider Demographics
NPI:1861427528
Name:KHAN-VARIBA, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:KHAN-VARIBA
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 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8030
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:1551 BISHOP ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4635
Practice Address - Country:US
Practice Address - Phone:805-269-1500
Practice Address - Fax:805-929-6440
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA305442080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABE373ZOtherPTAN W1508
CA1841217866Medicaid
CABE373UOtherPTAN 1508C
CABE373VOtherPTAN W1508F
CABE373XOtherPTAN 1508D
CABE373ZOtherPTAN W1508
CA1841217866Medicaid
CA1073533089Medicaid
CA1841217882Medicaid
CABE373WOtherPTAN W1508E
CA1275553257Medicaid
CABE373TOtherPTAN W1508A
CA1841217866Medicaid
CA551977Medicare Oscar/Certification
CABE373TOtherPTAN W1508A
CABE373ZOtherPTAN W1508
CABE373YOtherPTAN W1508B
CAE17555Medicare UPIN