Provider Demographics
NPI:1093305724
Name:KHAN, SALEM
Entity Type:Individual
Prefix:
First Name:SALEM
Middle Name:
Last Name:KHAN
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 1:620 LANCER CT APT B2
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1343
Mailing Address - Country:US
Mailing Address - Phone:716-563-4290
Mailing Address - Fax:
Practice Address - Street 1:620 LANCER CT APT B2
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1343
Practice Address - Country:US
Practice Address - Phone:716-563-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver