Healthcare Provider Details

I. General information

NPI: 1710081088
Provider Name (Legal Business Name): SHAHEEN KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W 4TH ST
MADERA CA
93637-4474
US

IV. Provider business mailing address

1111 W 4TH ST
MADERA CA
93637-4474
US

V. Phone/Fax

Practice location:
  • Phone: 559-673-3000
  • Fax: 559-662-2910
Mailing address:
  • Phone: 559-673-3000
  • Fax: 559-662-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC50433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: