Basic Information
| Provider Information | |||||||||
| NPI: | 1447588926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | SAIRA | ||||||||
| MiddleName: | HAROON | ||||||||
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| Credential: | M.D | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | HAROON | ||||||||
| OtherFirstName: | SAIRA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 600 COFFEE RD | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953554201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2095241211 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2151 W GRANT LINE RD | ||||||||
| Address2: | |||||||||
| City: | TRACY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953777309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098320535 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2009 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A110011 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.