Provider Demographics
NPI:1235330382
Name:KHAN, SOHAIL (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5801 S FASHION BLVD
Mailing Address - Street 2:STE 120
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8115
Mailing Address - Country:US
Mailing Address - Phone:801-261-1391
Mailing Address - Fax:801-261-1394
Practice Address - Street 1:5405 S 500 E STE 204
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-7420
Practice Address - Country:US
Practice Address - Phone:801-479-0184
Practice Address - Fax:801-479-5642
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA202616207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA02987Medicaid