Provider Demographics
NPI:1962693309
Name:SHAH, SHABANA KHAN (MD)
Entity type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:KHAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHABANA
Other - Middle Name:KAUSER
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:26526 CRAFTSMEN CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-5726
Mailing Address - Country:US
Mailing Address - Phone:310-809-9103
Mailing Address - Fax:
Practice Address - Street 1:393 E WALNUT STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188-2507
Practice Address - Country:US
Practice Address - Phone:310-809-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86063207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA6447OtherRAILROAD
CAM050376OtherHARBOR UCLA MEDICAL CENTER