Provider Demographics
NPI:1720397144
Name:KHAN, BAHADER (EP)
Entity Type:Individual
Prefix:MR
First Name:BAHADER
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4278 PARKHURST TER
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2076
Mailing Address - Country:US
Mailing Address - Phone:650-834-4551
Mailing Address - Fax:
Practice Address - Street 1:4278 PARKHURST TER
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2076
Practice Address - Country:US
Practice Address - Phone:650-834-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner