Provider Demographics
NPI:1164514352
Name:KHAN, KASHIF ZAFAR (MD)
Entity Type:Individual
Prefix:
First Name:KASHIF
Middle Name:ZAFAR
Last Name:KHAN
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 1:1606 COLERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6697
Mailing Address - Country:US
Mailing Address - Phone:832-623-1716
Mailing Address - Fax:
Practice Address - Street 1:2301 N BRAZOSPORT BLVD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-3257
Practice Address - Country:US
Practice Address - Phone:979-238-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22259207Q00000X, 2083X0100X
WI48476-202083X0100X
TXM73282083X0100X, 207Q00000X
WI48476-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y409Medicare PIN
TX8L17676Medicare PIN
TX8L22115Medicare UPIN