Healthcare Provider Details

I. General information

NPI: 1902542772
Provider Name (Legal Business Name): MS. SABRINA BEGUM KHAN I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date: 05/05/2022
Reactivation Date: 06/16/2026

III. Provider practice location address

541 S HAM LN STE A&B
LODI CA
95242-3059
US

IV. Provider business mailing address

541 S HAM LN STE A&B
LODI CA
95242-3059
US

V. Phone/Fax

Practice location:
  • Phone: 209-553-0798
  • Fax:
Mailing address:
  • Phone: 209-553-0798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: