Provider Demographics
NPI:1013095777
Name:KHAN, AMER H (MD)
Entity Type:Individual
Prefix:
First Name:AMER
Middle Name:H
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 DOUGLAS BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3851
Mailing Address - Country:US
Mailing Address - Phone:916-719-3372
Mailing Address - Fax:510-350-9190
Practice Address - Street 1:3001 DOUGLAS BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3851
Practice Address - Country:US
Practice Address - Phone:916-719-3372
Practice Address - Fax:510-350-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA667622084N0402X
CAA0667622084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A667620Medicaid
G16110Medicare UPIN
00A667620Medicare ID - Type Unspecified