1134322498 NPI number — DR. HARRIS KHAN KHAKWANI MD

Table of content: DR. HARRIS KHAN KHAKWANI MD (NPI 1134322498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134322498 NPI number — DR. HARRIS KHAN KHAKWANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAKWANI
Provider First Name:
HARRIS
Provider Middle Name:
KHAN
Provider Name Prefix Text:
DR.
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:
1134322498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3815 E BELL RD STE 2200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85032-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-633-3848
Provider Business Mailing Address Fax Number:
602-633-3841

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3540 E BASELINE RD
Provider Second Line Business Practice Location Address:
130
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85042-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-251-7559
Provider Business Practice Location Address Fax Number:
623-266-4012
Provider Enumeration Date:
06/06/2007

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: 207Q00000X , with the licence number:  42338 , 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: 449680 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com