Provider Demographics
NPI:1346289964
Name:KHAN, AMY J (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:J
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 KIRMAN AVE
Mailing Address - Street 2:VA SIERRA NEVADA HEALTH CARE SYSTEM
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-0993
Mailing Address - Country:US
Mailing Address - Phone:775-786-7200
Mailing Address - Fax:775-201-0154
Practice Address - Street 1:975 KIRMAN AVE
Practice Address - Street 2:VA SIERRA NEVADA HEALTH CARE SYSTEM
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-0993
Practice Address - Country:US
Practice Address - Phone:775-786-7200
Practice Address - Fax:775-201-0154
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG061956207R00000X, 2083P0901X
NV11174207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV004716904Medicaid
NV004716904Medicaid
NV100504Medicare ID - Type Unspecified