Provider Demographics
NPI:1093721672
Name:KHAN, AMAN SHABI (MD)
Entity Type:Individual
Prefix:
First Name:AMAN
Middle Name:SHABI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMAN
Other - Middle Name:QADEER
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2223
Mailing Address - Country:US
Mailing Address - Phone:650-756-5630
Mailing Address - Fax:650-756-0136
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2223
Practice Address - Country:US
Practice Address - Phone:650-756-5630
Practice Address - Fax:650-756-0136
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60839207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A608390Medicaid
CA0208450001OtherMEDICARE NSC GROUP
CAZZZ32209ZOtherGROUP MEDICARE
CAA60839OtherSTATE
CA200046337OtherMEDICARE RAILROAD
CA00A608390Medicaid
CA0208450001OtherMEDICARE NSC GROUP