Healthcare Provider Details

I. General information

NPI: 1245141613
Provider Name (Legal Business Name): SAMINA KHAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 GRANT RD
MOUNTAIN VIEW CA
94040-4302
US

IV. Provider business mailing address

11564 EVENING SPRING CT
CUPERTINO CA
95014-5117
US

V. Phone/Fax

Practice location:
  • Phone: 408-568-8628
  • Fax:
Mailing address:
  • Phone: 408-568-8628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMINA KHAN
Title or Position: STAFF PSYCHIATRIST
Credential: MD
Phone: 408-568-8628