Healthcare Provider Details

I. General information

NPI: 1457361578
Provider Name (Legal Business Name): MAZHAR ALI KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

18550 DEPAUL DRIVE #205
MORGAN HILL CA
95037
US

IV. Provider business mailing address

18550 DEPAUL DRIVE #205
MORGAN HILL CA
95037
US

V. Phone/Fax

Practice location:
  • Phone: 408-779-4188
  • Fax: 408-779-2178
Mailing address:
  • Phone: 408-779-4188
  • Fax: 408-779-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: