MEDICARE: KIREN KHAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	22565	CA

General Provider Information

NPI Number	:	1114195534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIREN KHAN FNP

Provider Business Mailing Address
First Line	:	1010 GOUGH ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-7622
Country	:	US
Telephone Number	:	415-474-7310
Fax Number	:	415-931-3773

Provider Business Practice Location Address
First Line	:	7248 S LAND PARK DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95831-3660
Country	:	US
Telephone Number	:	916-392-4000
Fax Number	:	916-392-4000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	10/17/2013

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