Provider Demographics
NPI:1700465523
Name:KHAN, CHRISTINE JAN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:JAN
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19401 SUSAN WAY
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9266
Mailing Address - Country:US
Mailing Address - Phone:209-588-6071
Mailing Address - Fax:
Practice Address - Street 1:564 MOUNTAIN RANCH RD # 5
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9782
Practice Address - Country:US
Practice Address - Phone:209-498-2227
Practice Address - Fax:209-049-8204
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW100134101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health