Provider Demographics
NPI:1972577518
Name:KHAN, YASMINE S (MD)
Entity Type:Individual
Prefix:
First Name:YASMINE
Middle Name:S
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YASMINE
Other - Middle Name:
Other - Last Name:SAYED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:460 HARTFORD TPKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4845
Mailing Address - Country:US
Mailing Address - Phone:860-896-4877
Mailing Address - Fax:860-896-4876
Practice Address - Street 1:460 HARTFORD TPKE
Practice Address - Street 2:SUITE A
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4845
Practice Address - Country:US
Practice Address - Phone:860-896-4877
Practice Address - Fax:860-896-4876
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040869207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001408691Medicaid
CT001408691Medicaid
H86469Medicare UPIN