Provider Demographics
NPI:1770518771
Name:KHAN, SHAHID M (MD)
Entity type:Individual
Prefix:
First Name:SHAHID
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17075 DEVONSHIRE ST
Mailing Address - Street 2:#101
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1600
Mailing Address - Country:US
Mailing Address - Phone:818-357-2262
Mailing Address - Fax:818-357-2270
Practice Address - Street 1:17075 DEVONSHIRE ST
Practice Address - Street 2:#101
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-1600
Practice Address - Country:US
Practice Address - Phone:818-357-2262
Practice Address - Fax:818-357-2270
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49009207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A490090Medicaid
CA00A490090Medicaid
CAA49009Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER