Individual provider Active NPI

Shahid M Khan, MD

  • Internal Medicine Physician
  • Northridge, CA
National Provider Identifier
1770518771
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A49009 Issued in CA
Practice address
17075 Devonshire St
#101
Northridge, CA 91325-1600
Phone
(818) 357-2262
Fax
(818) 357-2270
NPI assigned
Jul 11, 2006
Sex
Male
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 A49009 CA Primary

Addresses

Primary practice location

17075 Devonshire St
#101
Northridge, CA 91325-1600

Mailing address

17075 Devonshire St
#101
Northridge, CA 91325-1600
Phone (818) 357-2262

Other identifiers 1

IdentifierTypeStateIssuer
00A490090MedicaidCA

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
A49009CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Healthcare Inc. Internal Medicine PastSince May 1, 2008 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770518771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST",
            "address_2": "#101",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251600",
            "telephone_number": "818-357-2262",
            "fax_number": "818-357-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST",
            "address_2": "#101",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251600",
            "telephone_number": "818-357-2262",
            "fax_number": "818-357-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SHAHID",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A49009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A490090",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, 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.