Healthcare Provider Details

I. General information

NPI: 1750135349
Provider Name (Legal Business Name): ABDULLAH KHALID MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

IV. Provider business mailing address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 209-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TERESA MARTINEZ
Title or Position: PRACTICE MANAGER
Credential:
Phone: 209-464-6422