Provider Demographics
NPI:1215034277
Name:KHAN, JEMSHED A (MD)
Entity Type:Individual
Prefix:
First Name:JEMSHED
Middle Name:A
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 1:9650 NALL AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2952
Mailing Address - Country:US
Mailing Address - Phone:913-696-1154
Mailing Address - Fax:913-696-0984
Practice Address - Street 1:9650 NALL AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2952
Practice Address - Country:US
Practice Address - Phone:913-696-1154
Practice Address - Fax:913-696-0984
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421769207W00000X
MO36432207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO13341108OtherBCBS
KS100155470HMedicaid
KS100155470HMedicaid
B99175Medicare UPIN
MOM566823AMedicare ID - Type Unspecified