Healthcare Provider Details

I. General information

NPI: 1801056700
Provider Name (Legal Business Name): SONIA FAREEDA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39155 LIBERTY ST STE E500
FREMONT CA
94538-1516
US

IV. Provider business mailing address

39120 ARGONAUT WAY #363
FREMONT CA
94538-1304
US

V. Phone/Fax

Practice location:
  • Phone: 510-378-3036
  • Fax:
Mailing address:
  • Phone: 510-378-3036
  • Fax: 510-793-9216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA049044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA049044
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA049044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: