Healthcare Provider Details

I. General information

NPI: 1619760469
Provider Name (Legal Business Name): KHAN SEKANDARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2025
Last Update Date: 05/24/2025
Certification Date: 05/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9052 CORTINA CIR
ROSEVILLE CA
95678-2941
US

IV. Provider business mailing address

9052 CORTINA CIR
ROSEVILLE CA
95678-2941
US

V. Phone/Fax

Practice location:
  • Phone: 510-701-6855
  • Fax:
Mailing address:
  • Phone: 510-701-6855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95296909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: