Provider Demographics
NPI:1467504746
Name:KHAN, HASSAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:M
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 E CHANDLER BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-5117
Mailing Address - Country:US
Mailing Address - Phone:480-306-5151
Mailing Address - Fax:480-306-4648
Practice Address - Street 1:1915 E CHANDLER BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5117
Practice Address - Country:US
Practice Address - Phone:480-306-5151
Practice Address - Fax:480-306-4648
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40873207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ377971Medicaid
AZZ125671Medicare PIN