Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 30648 | OK |
Y | 207Q00000X | Family Doctor | A168924 | CA |
N | 207QA0401X | Family Doctor - Addiction Medicine | A168924 | CA |
N | 207QA0505X | Family Doctor - Adult Medicine | A168924 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A168924 | CA |
NPI | 1568881977 |
---|---|
Provider Name | Muhammad Shoaib Khan |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 08/06/2020 |