Provider Demographics
NPI:1104568252
Name:KHAN, JUNAID
Entity type:Individual
Prefix:
First Name:JUNAID
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5669 MERICREST WAY
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8386
Mailing Address - Country:US
Mailing Address - Phone:607-651-0025
Mailing Address - Fax:
Practice Address - Street 1:3100 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3239
Practice Address - Country:US
Practice Address - Phone:800-607-6377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1417962101213EP0504X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine