Provider Demographics
NPI:1952821555
Name:KHAN, IMAN SAJID (MD)
Entity Type:Individual
Prefix:
First Name:IMAN
Middle Name:SAJID
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 1:760 GOLF VIEW DR UNIT 200
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9685
Mailing Address - Country:US
Mailing Address - Phone:541-618-4400
Mailing Address - Fax:
Practice Address - Street 1:760 GOLF VIEW DR UNIT 200
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9685
Practice Address - Country:US
Practice Address - Phone:541-618-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD390200000X
ORMD208870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program