Provider Demographics
NPI:1417373556
Name:KHAN NOOHANI MD PA
Entity Type:Organization
Organization Name:KHAN NOOHANI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOOHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-319-2020
Mailing Address - Street 1:5740 COBBLESTONE LN
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2539
Mailing Address - Country:US
Mailing Address - Phone:954-319-2020
Mailing Address - Fax:
Practice Address - Street 1:1323 NORTH A STREET
Practice Address - Street 2:SUMNER REGIONAL MEDICAL CENTER
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152
Practice Address - Country:US
Practice Address - Phone:620-326-7451
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS08-00309273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit