Tariq Ali Khan MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A112661 Issued in CA

Legal business name

TARIQ ALI KHAN MD

Practice address

14642 Newport Ave
Suite 408
Tustin, CA 92780-6057

Phone

(657) 218-9859

Fax

(657) 218-4023

NPI assigned

Jul 25, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tariq Ali Khan, MD

Title

Owner

Phone

(657) 218-9859

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1033662101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE",
            "address_2": "SUITE 408",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806057",
            "telephone_number": "657-218-9859",
            "fax_number": "657-218-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE",
            "address_2": "SUITE 408",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806057",
            "telephone_number": "657-218-9859",
            "fax_number": "657-218-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARIQ ALI KHAN MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-25",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "TARIQ",
        "authorized_official_middle_name": "ALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "657-218-9859",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A112661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1295925253",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Tustin, CA
• Providers in Tustin, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.