Provider Demographics
NPI:1952398604
Name:KHAN, YASIN (MD)
Entity Type:Individual
Prefix:DR
First Name:YASIN
Middle Name:
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 1:1146 S. CEDAR CREST BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7938
Mailing Address - Country:US
Mailing Address - Phone:610-366-9000
Mailing Address - Fax:610-366-9229
Practice Address - Street 1:1146 S. CEDAR CREST BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7938
Practice Address - Country:US
Practice Address - Phone:610-366-9000
Practice Address - Fax:610-366-9229
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040917Y207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA591182Medicaid
PA591182Medicaid
PA591182Medicare ID - Type Unspecified