Provider Demographics
NPI:1043409873
Name:KHAJA, FAIZUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:FAIZUDDIN
Middle Name:
Last Name:KHAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 CHANCELLOR DR
Mailing Address - Street 2:STE 215
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3931
Mailing Address - Country:US
Mailing Address - Phone:859-581-7120
Mailing Address - Fax:859-581-7207
Practice Address - Street 1:2055 READING RD
Practice Address - Street 2:SUITE 330
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-1461
Practice Address - Country:US
Practice Address - Phone:513-381-1900
Practice Address - Fax:513-287-6403
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097073207W00000X, 207WX0107X
KY44434207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100170190Medicaid
OH0050894Medicaid
KYK015020Medicare PIN
OH0050894Medicaid
OHH015410Medicare PIN