Provider Demographics
NPI:1871805283
Name:PANNA A KHAN
Entity type:Organization
Organization Name:PANNA A KHAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PANNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-928-2609
Mailing Address - Street 1:10348 PARAMOUNT BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2360
Mailing Address - Country:US
Mailing Address - Phone:562-928-2609
Mailing Address - Fax:
Practice Address - Street 1:10348 PARAMOUNT BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2360
Practice Address - Country:US
Practice Address - Phone:562-928-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health