Provider Demographics
NPI:1639134828
Name:KHAN, SHAHABUDDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHABUDDIN
Middle Name:
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 1:700 E SILVERADO RANCH BLVD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7516
Mailing Address - Country:US
Mailing Address - Phone:702-240-6482
Mailing Address - Fax:702-804-0957
Practice Address - Street 1:3150 N TENAYA WAY
Practice Address - Street 2:STE. 320
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0443
Practice Address - Country:US
Practice Address - Phone:702-240-6482
Practice Address - Fax:702-804-0957
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11499207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507025Medicaid
NV100507025Medicaid
NV103227Medicare PIN