MEDICARE: DR. KAMRAN YUNAS KHATTAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	22201	WV
2	207L00000X	Anesthesiology Physician	256085	NY
3	207L00000X	Anesthesiology Physician	036-124855	IL
4	207L00000X	Anesthesiology Physician	0101247784	VA

General Provider Information

NPI Number	:	1710946850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAMRAN YUNAS KHATTAK M.D.

Provider Business Mailing Address
First Line	:	423 WOODBRIDGE DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-9731
Country	:	US
Telephone Number	:	516-902-9827
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 WOODBRIDGE DR
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-9731
Country	:	US
Telephone Number	:	516-902-2827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	06/17/2026

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