Provider Demographics
NPI:1487716510
Name:KHAN, FAROOQ HA (DDS)
Entity type:Individual
Prefix:
First Name:FAROOQ
Middle Name:HA
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 JULPUN LOOP
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1226
Mailing Address - Country:US
Mailing Address - Phone:818-458-6658
Mailing Address - Fax:
Practice Address - Street 1:2590 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2909
Practice Address - Country:US
Practice Address - Phone:925-776-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice