1588753420 NPI number — KHALID M KHAN MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588753420 NPI number — KHALID M KHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
KHALID
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588753420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 N CAMPBELL AVE
Provider Second Line Business Mailing Address:
UNIVERSITY OF ARIZONA MEDICAL CENTER SUITE 4325F
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85724-5066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-626-6211
Provider Business Mailing Address Fax Number:
520-626-9226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N CAMPBELL AVE
Provider Second Line Business Practice Location Address:
UNIVERSITY OF ARIZONA MEDICAL CENTER SUITE 4325F
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85724-5066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-626-6211
Provider Business Practice Location Address Fax Number:
520-626-9226
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0206X , with the licence number:  40430 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1344716 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".




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