Provider Demographics
NPI:1295778215
Name:KHAN, MOHAMMAD NAEEMULLAH (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:NAEEMULLAH
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 1:525 N 18TH ST
Mailing Address - Street 2:SUITE # 601
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4102
Mailing Address - Country:US
Mailing Address - Phone:602-307-9112
Mailing Address - Fax:602-307-9155
Practice Address - Street 1:2241 WANKEL WAY STE A
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0191
Practice Address - Country:US
Practice Address - Phone:805-983-0521
Practice Address - Fax:805-983-4186
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30038207RG0100X
NMMD2022-1353207RG0100X
KYC0072207RG0100X
WV29905207RG0100X
CAC-183205207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ639130Medicaid
AZH04459Medicare UPIN
AZ639130Medicaid