Provider Demographics
NPI:1770042608
Name:KHAN, SUNNA (MD)
Entity Type:Individual
Prefix:
First Name:SUNNA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CRAIG RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7133
Mailing Address - Country:US
Mailing Address - Phone:314-872-7792
Mailing Address - Fax:314-872-5655
Practice Address - Street 1:777 CRAIG RD STE 130
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7133
Practice Address - Country:US
Practice Address - Phone:314-872-7792
Practice Address - Fax:314-872-5655
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210285792084P0800X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program