MEDICARE: ALEENA KHAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	112010	CA

General Provider Information

NPI Number	:	1710878822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEENA KHAN DMD

Provider Business Mailing Address
First Line	:	PO BOX 622
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-0622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1197 E LOS ANGELES AVE STE E
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2868
Country	:	US
Telephone Number	:	916-501-7435
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2025
Last Update Date	:	07/15/2025

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