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General NPI Number Information
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NPI Number | 1194390534
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Entity Type | Individual
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Provider Name | SHOAIB KHAN
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Gender | Male
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 07/04/2022
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Provider Practice Location Address
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Address Line | 7901 WATT AVE
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City | ANTELOPE
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State | CA
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Zip | 95843-2002
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Country | US
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Telephone | 209-914-5851
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 W PACHECO BLVD
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City | LOS BANOS
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State | CA
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Zip | 93635-8505
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Country | US
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Telephone | 209-826-9653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | INT-44093
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License Number State | CA
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