Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 42854 | TN |
Y | 207PP0204X | Pediatric Emergency Physician | A99004 | CA |
N | 208000000X | Pediatrician | R5882 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | R5882 | TX |
NPI | 1083732648 |
---|---|
Provider Name | Dr. Shehma Khan |
First Address | Villa Park, CA 92861-4200 |
Second Address | Madera, CA 93636-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3000899 | (05) | TN |