Provider Demographics
NPI:1366464356
Name:MADAN, KHORSHED (MD)
Entity Type:Individual
Prefix:DR
First Name:KHORSHED
Middle Name:
Last Name:MADAN
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 1:900 VETERANS BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1715
Mailing Address - Country:US
Mailing Address - Phone:650-298-8774
Mailing Address - Fax:650-288-4180
Practice Address - Street 1:900 VETERANS BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1715
Practice Address - Country:US
Practice Address - Phone:650-298-8774
Practice Address - Fax:650-288-4180
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049822207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F51008Medicare UPIN
ZZZ16205ZMedicare ID - Type Unspecified