Provider Demographics
NPI:1780662890
Name:KHAN, SHAKEELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAKEELA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 PATRIOT PL
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-6309
Mailing Address - Country:US
Mailing Address - Phone:510-676-6456
Mailing Address - Fax:510-229-1937
Practice Address - Street 1:40961 GRIMMER BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2846
Practice Address - Country:US
Practice Address - Phone:510-226-1900
Practice Address - Fax:510-226-1937
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice