Healthcare Provider Details

I. General information

NPI: 1659020204
Provider Name (Legal Business Name): OMAR KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2022
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY ST LBBY 2
SAN FRANCISCO CA
94107-5705
US

IV. Provider business mailing address

185 BERRY STREET, LOBBY 2, SUITE 100 BOX 0506
SAN FRANCISCO CA
94107
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberA189466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: