| Tariq Ali Khan Md | |
|
14642 Newport Ave Suite 408 Tustin CA 92780-6057 | |
| (657) 218-9859 | |
| (657) 218-4023 |
| Full Name | Tariq Ali Khan Md |
|---|---|
| Speciality | Internal Medicine |
| Location | 14642 Newport Ave, Tustin, California |
| Authorized Official Name and Position | Tariq Ali Khan (OWNER) |
| Authorized Official Contact | 6572189859 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tariq Ali Khan Md 14642 Newport Ave Suite 408 Tustin CA 92780-6057 Ph: (657) 218-9859 | Tariq Ali Khan Md 14642 Newport Ave Suite 408 Tustin CA 92780-6057 Ph: (657) 218-9859 |
| NPI Number | 1033662101 |
|---|---|
| Provider Enumeration Date | 07/25/2016 |
| Last Update Date | 06/11/2024 |
| Medicare PECOS PAC ID | 8022385418 |
|---|---|
| Medicare Enrollment ID | O20170607000648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033662101 | NPI | - | NPPES |
| 1295925253 | Other | CA | NPI INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A112661 (California) | Primary |
| Provider Name | Tariq Ali Khan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295925253 PECOS PAC ID: 0143397190 Enrollment ID: I20110926000255 |
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