Healthcare Provider Details

I. General information

NPI: 1447871926
Provider Name (Legal Business Name): UMAR KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 MARCONI AVE
SACRAMENTO CA
95821-5303
US

IV. Provider business mailing address

3628 RIDGEVIEW DR
EL DORADO HILLS CA
95762-4427
US

V. Phone/Fax

Practice location:
  • Phone: 916-548-2505
  • Fax:
Mailing address:
  • Phone: 916-548-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: