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General NPI Number Information
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NPI Number | 1215234737
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Entity Type | Individual
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Provider Name | MUHAMMAD KHURSHID KHAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 1090 LA PLAYA DR
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City | HAYWARD
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State | CA
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Zip | 94545-2142
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Country | US
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Telephone | 510-785-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 814 HANCOCK ST APT 702
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City | HAYWARD
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State | CA
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Zip | 94544-4981
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Country | US
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Telephone | 510-862-8336
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA21468
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License Number State | CA
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