Healthcare Provider Details

I. General information

NPI: 1730046624
Provider Name (Legal Business Name): SOMMAIYA KHAN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUMAIYA KHAN IBCLC

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3369 HACIENDA WAY
ANTIOCH CA
94509-5407
US

IV. Provider business mailing address

3369 HACIENDA WAY
ANTIOCH CA
94509-5407
US

V. Phone/Fax

Practice location:
  • Phone: 951-285-5738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number319278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: