Provider Demographics
NPI:1629156203
Name:KHAN, SHAHID NADEEM (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:NADEEM
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KHAN
Other - Middle Name:
Other - Last Name:MEDICAL ASSOCIATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2295 CORAL BELL CT
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7903
Mailing Address - Country:US
Mailing Address - Phone:831-578-9772
Mailing Address - Fax:831-603-4600
Practice Address - Street 1:2295 CORAL BELL CT
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7903
Practice Address - Country:US
Practice Address - Phone:831-578-9772
Practice Address - Fax:831-603-4600
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94964207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA94964OtherCA LIC #