Healthcare Provider Details

I. General information

NPI: 1730715723
Provider Name (Legal Business Name): SARA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2020
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 S PALISADE DR
SANTA MARIA CA
93454-5948
US

IV. Provider business mailing address

235 S PALISADE DR
SANTA MARIA CA
93454-5948
US

V. Phone/Fax

Practice location:
  • Phone: 805-739-3561
  • Fax: 805-739-3560
Mailing address:
  • Phone: 805-739-3561
  • Fax: 805-739-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA185741
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61058424
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: