Provider Demographics
NPI:1073018677
Name:SAHA, KHOKON KUMAR
Entity Type:Individual
Prefix:
First Name:KHOKON
Middle Name:KUMAR
Last Name:SAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 168TH ST APT 1M
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4305
Mailing Address - Country:US
Mailing Address - Phone:646-552-7832
Mailing Address - Fax:
Practice Address - Street 1:8815 168TH ST APT 1M
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4305
Practice Address - Country:US
Practice Address - Phone:646-552-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
021938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical