Provider Demographics
NPI:1457361578
Name:KHAN, MAZHAR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZHAR
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:18550 DEPAUL DRIVE
Mailing Address - Street 2:#205
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-779-4188
Mailing Address - Fax:408-779-2178
Practice Address - Street 1:18550 DEPAUL DRIVE
Practice Address - Street 2:#205
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037
Practice Address - Country:US
Practice Address - Phone:408-779-4188
Practice Address - Fax:408-779-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49590208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495900Medicaid
E69881Medicare UPIN