Healthcare Provider Details

I. General information

NPI: 1104951227
Provider Name (Legal Business Name): RAHEEL AHMAD KHAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 10/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 FOLSOM BLVD
SACRAMENTO CA
95826-2608
US

IV. Provider business mailing address

PO BOX 981233
WEST SACRAMENTO CA
95798-1233
US

V. Phone/Fax

Practice location:
  • Phone: 510-565-0931
  • Fax: 916-668-6878
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number20A10420
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A10420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: