Individual provider Active NPI

Khusro Naz Shakir

  • Internal Medicine Physician
  • San Jose, CA
National Provider Identifier
1720170657
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A45293 Issued in CA
Practice address
135 N Jackson Ave
Suite #103
San Jose, CA 95115-1917
Phone
(408) 923-8840
Fax
(408) 258-0513
NPI assigned
Sep 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A45293 CA Primary

Addresses

Primary practice location

135 N Jackson Ave
Suite #103
San Jose, CA 95115-1917

Mailing address

135 N Jackson Ave
Suite #103
San Jose, CA 95115-1917
Phone (408) 923-8840

Other identifiers 1

IdentifierTypeStateIssuer
00A452930MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A45293CAMDInternal Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720170657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N JACKSON AVE",
            "address_2": "SUITE #103",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951151917",
            "telephone_number": "408-923-8840",
            "fax_number": "408-258-0513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N JACKSON AVE",
            "address_2": "SUITE #103",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951151917",
            "telephone_number": "408-923-8840",
            "fax_number": "408-258-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKIR",
        "first_name": "KHUSRO",
        "middle_name": "NAZ",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A45293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A452930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.