Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 51483 | CA |
NPI | 1093773632 |
---|---|
Provider Name | Ghazala Rahman Khan |
First Address | San Ramon, CA 94582-5710 |
Second Address | Manteca, CA 95337-4316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 17/10/2013 |