Provider Demographics
NPI:1164734489
Name:KHAN, MUTAHIR UBAID (MD)
Entity Type:Individual
Prefix:DR
First Name:MUTAHIR
Middle Name:UBAID
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPANOS CT
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2810
Mailing Address - Country:US
Mailing Address - Phone:209-522-9863
Mailing Address - Fax:
Practice Address - Street 1:1401 SPANOS CT
Practice Address - Street 2:SUITE 230
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-2810
Practice Address - Country:US
Practice Address - Phone:209-522-9863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112898207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease