Provider Demographics
NPI:1578597332
Name:KHANDAKER, NURUN NAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NURUN
Middle Name:NAHAR
Last Name:KHANDAKER
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 1:300 OLD RIVER ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311
Mailing Address - Country:US
Mailing Address - Phone:661-665-0184
Mailing Address - Fax:661-665-8219
Practice Address - Street 1:300 OLD RIVER ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311
Practice Address - Country:US
Practice Address - Phone:661-665-0184
Practice Address - Fax:661-665-8219
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F96644Medicare UPIN
CA00A514150Medicare ID - Type Unspecified