Provider Demographics
NPI:1407026420
Name:KHAN, QAMAR (DO)
Entity Type:Individual
Prefix:
First Name:QAMAR
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 W 10600 S
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8524
Mailing Address - Country:US
Mailing Address - Phone:801-302-2960
Mailing Address - Fax:801-302-2963
Practice Address - Street 1:661 W 10600 S
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8524
Practice Address - Country:US
Practice Address - Phone:801-302-2960
Practice Address - Fax:801-302-2963
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A103562081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine