Provider Demographics
NPI:1679736672
Name:KHAN, SAMIRA (MD)
Entity type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 ENTERPRISE STE 200
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2626
Mailing Address - Country:US
Mailing Address - Phone:949-688-6205
Mailing Address - Fax:
Practice Address - Street 1:27871 MEDICAL CENTER RD STE 120
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6405
Practice Address - Country:US
Practice Address - Phone:714-901-2006
Practice Address - Fax:714-901-2004
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC172118207W00000X
IL128133207W00000X
NY252224207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology