Healthcare Provider Details

I. General information

NPI: 1205975992
Provider Name (Legal Business Name): KHURSHID KHAN MUHAMMAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PLAZA DR STE 170
ROSEVILLE CA
95661-2867
US

IV. Provider business mailing address

1820 J ST
SACRAMENTO CA
95811-3010
US

V. Phone/Fax

Practice location:
  • Phone: 916-978-1738
  • Fax: 916-771-3377
Mailing address:
  • Phone: 916-550-5481
  • Fax: 916-520-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA88905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: