Provider Demographics
NPI:1821044520
Name:KHAN, ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:ASIF
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 1:102B 23RD AVE SE # B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-4527
Mailing Address - Country:US
Mailing Address - Phone:253-200-0300
Mailing Address - Fax:253-320-2095
Practice Address - Street 1:102B 23RD AVE SE # B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4527
Practice Address - Country:US
Practice Address - Phone:253-200-0300
Practice Address - Fax:253-320-2095
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0195278OtherL & I PROVIDER NUMBER
WA98390A019OtherTRICARE PROVIDER NUMBER
WA9865KAOtherREGENCE RIDER NUMBER
WA8421091Medicaid
WA911203494BZOtherKPS PROVIDER NUMBER
WA0251533OtherL&I PROVIDER #
WA7386691OtherAETNA PROVIDER NUMBER
WA0195278OtherL & I PROVIDER NUMBER
WA911203494BZOtherKPS PROVIDER NUMBER