Provider Demographics
NPI:1669662151
Name:KHAN, ASIM (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIM
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4340 E INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 21473
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5360
Mailing Address - Country:US
Mailing Address - Phone:480-986-7246
Mailing Address - Fax:480-986-7252
Practice Address - Street 1:2045 S VINEYARD
Practice Address - Street 2:SUITE 131
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6889
Practice Address - Country:US
Practice Address - Phone:480-986-7246
Practice Address - Fax:480-986-7252
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ36668208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ242246Medicaid
AZ36668OtherARIZONA LICENSE
2Z7342OtherHEALTHNET
P00461169OtherRAILROAD MEDICARE