Provider Demographics
NPI:1447394812
Name:KHAN, SHAHID OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:OMAR
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 1:2760 W PILLSBURY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-6439
Mailing Address - Country:US
Mailing Address - Phone:661-305-0134
Mailing Address - Fax:
Practice Address - Street 1:38350 40TH ST E
Practice Address - Street 2:#100
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-3075
Practice Address - Country:US
Practice Address - Phone:661-225-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine