Healthcare Provider Details

I. General information

NPI: 1538426770
Provider Name (Legal Business Name): ASIM KHAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S GILBERT RD STE 115
GILBERT AZ
85296-2262
US

IV. Provider business mailing address

13203 N 103RD AVE STE H5
SUN CITY AZ
85351-3032
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-2961
  • Fax: 480-507-2971
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR2270
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number007078
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number007078
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: