Healthcare Provider Details

I. General information

NPI: 1982316287
Provider Name (Legal Business Name): TAMSEEL KHAN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ILENE ST
MARTINEZ CA
94553-2631
US

IV. Provider business mailing address

2976 SANTOS LN APT B205
WALNUT CREEK CA
94597-7500
US

V. Phone/Fax

Practice location:
  • Phone: 925-655-0567
  • Fax:
Mailing address:
  • Phone: 510-565-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number729076
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number729076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: