Provider Demographics
NPI:1528189842
Name:NADEEM TAHIR-KHELI, M.D., INC.
Entity Type:Organization
Organization Name:NADEEM TAHIR-KHELI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NADEEM
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAHIR-KHELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-939-3840
Mailing Address - Street 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:209-939-3840
Mailing Address - Fax:
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:209-939-3840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A717460Medicaid
CA00A717460Medicaid
CA00A717461Medicare ID - Type Unspecified