Provider Demographics
NPI:1851104228
Name:KHATTAK, NAUMAN
Entity type:Individual
Prefix:
First Name:NAUMAN
Middle Name:
Last Name:KHATTAK
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 1:123 ADOBE CT APT D
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6267
Mailing Address - Country:US
Mailing Address - Phone:209-452-7002
Mailing Address - Fax:
Practice Address - Street 1:123 ADOBE CT APT D
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6267
Practice Address - Country:US
Practice Address - Phone:209-452-7002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF4965490172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver