Healthcare Provider Details

I. General information

NPI: 1447588926
Provider Name (Legal Business Name): SAIRA HAROON KHAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAIRA HAROON

II. Dates (important events)

Enumeration Date: 11/22/2009
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 W GRANT LINE RD
TRACY CA
95377-7309
US

IV. Provider business mailing address

600 COFFEE RD
MODESTO CA
95355-4201
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-0535
  • Fax:
Mailing address:
  • Phone: 209-524-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA110011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: