Healthcare Provider Details

I. General information

NPI: 1346464765
Provider Name (Legal Business Name): RANA MAHFOOZ ALI KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3390
  • Fax: 916-733-3394
Mailing address:
  • Phone: 916-379-2912
  • Fax: 916-859-1671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM7330
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC54497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: