Healthcare Provider Details

I. General information

NPI: 1962693309
Provider Name (Legal Business Name): SHABANA KHAN SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHABANA KAUSER KHAN M.D.

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT STREET 3RD FLOOR
PASADENA CA
91188-2507
US

IV. Provider business mailing address

26526 CRAFTSMEN CT
SANTA CLARITA CA
91350-5726
US

V. Phone/Fax

Practice location:
  • Phone: 310-809-9103
  • Fax:
Mailing address:
  • Phone: 310-809-9103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA86063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: