Provider Demographics
NPI:1285012385
Name:LA KHAN MDPA
Entity Type:Organization
Organization Name:LA KHAN MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAEEQ
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-440-9500
Mailing Address - Street 1:17070 RED OAK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2615
Mailing Address - Country:US
Mailing Address - Phone:281-440-9500
Mailing Address - Fax:281-440-9503
Practice Address - Street 1:17070 RED OAK DR STE 202
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2615
Practice Address - Country:US
Practice Address - Phone:281-440-9500
Practice Address - Fax:281-440-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7139261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121100501Medicaid
TX121100503Medicaid
TX281366902Medicaid
TX281366903Medicaid