Healthcare Provider Details

I. General information

NPI: 1053798629
Provider Name (Legal Business Name): ASFAND KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2015
Last Update Date: 11/23/2024
Certification Date: 11/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SMITH RANCH RD
SAN RAFAEL CA
94903-1939
US

IV. Provider business mailing address

111 SMITH RANCH RD
SAN RAFAEL CA
94903-1939
US

V. Phone/Fax

Practice location:
  • Phone: 415-491-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA170099
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA170099
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: