Provider Demographics
NPI:1699395947
Name:KHAN, KOMAL (IBCLC)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 CENTO CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6329
Mailing Address - Country:US
Mailing Address - Phone:214-364-7022
Mailing Address - Fax:
Practice Address - Street 1:569 CENTO CT
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6329
Practice Address - Country:US
Practice Address - Phone:214-364-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN