Provider Demographics
NPI:1114195534
Name:KHAN, KIREN (FNP)
Entity Type:Individual
Prefix:
First Name:KIREN
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GOUGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7622
Mailing Address - Country:US
Mailing Address - Phone:415-474-7310
Mailing Address - Fax:415-931-3773
Practice Address - Street 1:7248 S LAND PARK DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3660
Practice Address - Country:US
Practice Address - Phone:916-392-4000
Practice Address - Fax:916-392-4000
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily