Healthcare Provider Details

I. General information

NPI: 1487094579
Provider Name (Legal Business Name): FAEZA F KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

589 LOS COCHES ST
MILPITAS CA
95035-5423
US

IV. Provider business mailing address

589 LOS COCHES ST
MILPITAS CA
95035-5423
US

V. Phone/Fax

Practice location:
  • Phone: 408-945-2933
  • Fax:
Mailing address:
  • Phone: 408-945-2933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2013018532
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: