Provider Demographics
NPI:1699884437
Name:KHADE, USHAKIRAN (MD)
Entity type:Individual
Prefix:DR
First Name:USHAKIRAN
Middle Name:
Last Name:KHADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRAN
Other - Middle Name:SHIVAJI
Other - Last Name:KHADE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1803 MORELAND DR
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1643
Mailing Address - Country:US
Mailing Address - Phone:510-220-3294
Mailing Address - Fax:510-865-6066
Practice Address - Street 1:1406 PARK ST # 100
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4558
Practice Address - Country:US
Practice Address - Phone:510-865-6000
Practice Address - Fax:510-865-6066
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51012208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1466135Medicaid
G59492Medicare UPIN
CA1466135Medicaid