Provider Demographics
NPI:1326045196
Name:KHAKOO, FATMA (MD)
Entity Type:Individual
Prefix:
First Name:FATMA
Middle Name:
Last Name:KHAKOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-727-3256
Mailing Address - Fax:510-727-3107
Practice Address - Street 1:20103 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5305
Practice Address - Country:US
Practice Address - Phone:510-727-3256
Practice Address - Fax:510-727-3107
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA809623207R00000X
CAA106306208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505420Medicaid
CC7755OtherBLUE CROSS BLUE SHIELD
CAA106306OtherSTATE LICENSE
NV100505420Medicaid
NVV100291Medicare PIN