Basic Information
Provider Information | |||||||||
NPI: | 1720432453 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KHAN | ||||||||
FirstName: | NADIR | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 325 DISTEL CIR | ||||||||
Address2: |   | ||||||||
City: | LOS ALTOS | ||||||||
State: | CA | ||||||||
PostalCode: | 940221408 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6508457649 | ||||||||
FaxNumber: | 6613262950 | ||||||||
Practice Location | |||||||||
Address1: | 3901 LONE TREE WAY STE 211 | ||||||||
Address2: |   | ||||||||
City: | ANTIOCH | ||||||||
State: | CA | ||||||||
PostalCode: | 94509 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9257561192 | ||||||||
FaxNumber: | 9257797220 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/19/2016 | ||||||||
LastUpdateDate: | 09/23/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A158336 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | A158336 | CA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | A158336 | 01 | CA | STATE MEDICAL LICENSE | OTHER |