Provider Demographics
NPI:1801969886
Name:KHAN, SHIREEN ENETTE (MD)
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:ENETTE
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98401-1535
Mailing Address - Country:US
Mailing Address - Phone:253-761-4200
Mailing Address - Fax:253-383-3553
Practice Address - Street 1:1304 FAWCETT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1911
Practice Address - Country:US
Practice Address - Phone:253-761-4200
Practice Address - Fax:253-383-3553
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000275132085R0202X
WAMD000362282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA126222OtherLABOR AND INDUSTRIES/WC TRA
WA300095008OtherRR MEDICARE UNION AVENUE OPEN
WAG8927711OtherPTAN-UAOM
WAKH8284OtherREGENCE BLUE SHIELD TRA
WA8238743Medicaid
WAG8882898OtherPTAN-MIO1
WA0249541OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WA157409OtherLABOR AND INDUSTRIES/WC UNION AVENUE OPEN
WA300095009OtherRR MEDICARE TRA
WAAB36525OtherMEDICARE PIN TRA KING COUNTY
WA7252KHOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA8951843OtherLABOR AND INDUSTRIES CRIME VICTIMS-MEDICAL IMAGING ON 1ST
WAAB34171OtherMEDICARE PIN UNION AVE OPEN
WAGAB08582Medicare PIN
WAG8927711OtherPTAN-UAOM
WA7252KHOtherREGENCE BLUE SHIELD UNION AVENUE OPEN
WA300095009OtherRR MEDICARE TRA
WAAB34171OtherMEDICARE PIN UNION AVE OPEN