Individual provider Active NPI

Rizwana Adam Khan, LVN

  • Licensed Vocational Nurse
  • Newark, CA
National Provider Identifier
1730996455
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Vocational NurseTaxonomy code 164X00000X
License
VN158685 Issued in CA
Practice address
6460 Normandy Dr
Newark, CA 94560-1131
Phone
(408) 903-7768
NPI assigned
Dec 16, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Vocational NurseGroup: 193400000X SINGLE SPECIALTY GROUP 164X00000X 158586 CA
Licensed Vocational Nurse 164X00000X VN158685 CA Primary

Addresses

Primary practice location

6460 Normandy Dr
Newark, CA 94560-1131

Mailing address

2425 Enborg LN
San Jose, CA 95128-2648
Phone (408) 885-5487

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
158586CAMDLicensed Vocational Nurse
VN158685CAMDLicensed Vocational Nurse

NPI Registry JSON

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

{
    "created_epoch": "1734307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1730996455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 ENBORG LN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951282648",
            "telephone_number": "408-885-5487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6460 NORMANDY DR",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945601131",
            "telephone_number": "408-903-7768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "RIZWANA",
        "middle_name": "ADAM",
        "credential": "LVN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-12-16",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "158586",
            "primary": false
        },
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN158685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.