Provider Demographics
NPI:1073785325
Name:CHISTY, KHAJA NAJIBUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KHAJA
Middle Name:NAJIBUDDIN
Last Name:CHISTY
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 1:9220 TEDDY LN STE 1600
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6756
Mailing Address - Country:US
Mailing Address - Phone:303-305-7785
Mailing Address - Fax:786-930-4110
Practice Address - Street 1:9220 TEDDY LN STE 1600
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-305-7785
Practice Address - Fax:786-930-4110
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00512652084P0800X
CODR 512652084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC230 514 77 1270OtherDRIVERS LICENSE FLORIDA