Healthcare Provider Details

I. General information

NPI: 1912320615
Provider Name (Legal Business Name): ASMINA KHAN MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2014
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4986 CHERRY AVE
SAN JOSE CA
95118-2748
US

IV. Provider business mailing address

4986 CHERRY AVE
SAN JOSE CA
95118-2748
US

V. Phone/Fax

Practice location:
  • Phone: 408-645-6760
  • Fax: 408-356-0273
Mailing address:
  • Phone: 408-645-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA79732
License Number StateCA

VIII. Authorized Official

Name: ASMINA KHAN
Title or Position: OWNER, PHYSICIAN
Credential: MD
Phone: 408-645-6760