MEDICARE: FATMA KHAKOO MD

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	207R00000X	Internal Medicine Physician	809623	CA
2	208M00000X	Hospitalist Physician	A106306	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	CC7755	OTHER		BLUE CROSS BLUE SHIELD
3	A106306	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1326045196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FATMA KHAKOO MD

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	510-727-3256
Fax Number	:	510-727-3107

Provider Business Practice Location Address
First Line	:	20103 LAKE CHABOT RD
Second Line	:
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5305
Country	:	US
Telephone Number	:	510-727-3256
Fax Number	:	510-727-3107

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/30/2019

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Directions to “ FATMA KHAKOO MD” Practice Location

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