Provider Demographics
NPI:1164445417
Name:KHAN, JEHANZEB (MBBS)
Entity Type:Individual
Prefix:DR
First Name:JEHANZEB
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 EVERGREEN GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-5911
Mailing Address - Country:US
Mailing Address - Phone:270-234-1421
Mailing Address - Fax:
Practice Address - Street 1:1321 RING RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8940
Practice Address - Country:US
Practice Address - Phone:270-986-7372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME948762085U0001X
KY409542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000535586OtherANTHEM BCBS
KY50016512OtherPASSPORT
KY50016512OtherPASSPORT
KYOTH000Medicare UPIN