Provider Demographics
NPI:1164597167
Name:KHAN, SHAHBAZ AMIR (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SHAHBAZ
Middle Name:AMIR
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 1:4228 WISCONSIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2138
Mailing Address - Country:US
Mailing Address - Phone:202-885-5600
Mailing Address - Fax:
Practice Address - Street 1:4228 WISCONSIN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2138
Practice Address - Country:US
Practice Address - Phone:202-885-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1005002084P0800X
DCMD0458352084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAZ831ROtherMEDICARE PTAN
CAAZ831SOtherMEDICARE PTAN
CAAZ831WOtherMEDICARE PTAN
CAAZ831ZOtherMEDICARE PTAN
CAAZ831TOtherMEDICARE PTAN
CAAZ831XOtherMEDICARE PTAN
CAAZ831YOtherMEDICARE PTAN
CAAZ831UOtherMEDICARE PTAN
CAAZ831VOtherMEDICARE PTAN