Provider Demographics
NPI:1982672150
Name:KHAN, ZAFRULLA (DDSMS)
Entity Type:Individual
Prefix:PROF
First Name:ZAFRULLA
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:DDSMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S JACKSON ST
Mailing Address - Street 2:BROWN CANCER CENTER STE 127
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3229
Mailing Address - Country:US
Mailing Address - Phone:502-852-5747
Mailing Address - Fax:502-852-6132
Practice Address - Street 1:529 S JACKSON ST
Practice Address - Street 2:BROWN CANCER CENTER STE 127
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-852-5747
Practice Address - Fax:502-852-6132
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY50671223P0700X
KY5067/500204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0003831OtherPASSPORT
KY611014882OtherUNITED HEALTH CARE
IN100018200OtherINDIANA MEDICAID
KY2437178000OtherPASSPORT ADVANTAGE
KY60050671Medicaid
KY611014882002OtherHEALTH NET TRICARE
KY190005666OtherRR MEDICARE
KY5651497OtherAETNA
KY775656OtherUNITED CONN
KY0003831OtherPASSPORT
KYT83090Medicare UPIN