Healthcare Provider Details

I. General information

NPI: 1134322498
Provider Name (Legal Business Name): HARRIS KHAN KHAKWANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 E BASELINE RD 130
PHOENIX AZ
85042-9627
US

IV. Provider business mailing address

PO BOX 660047
DALLAS TX
75266-2900
US

V. Phone/Fax

Practice location:
  • Phone: 623-251-7559
  • Fax: 623-266-4012
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42338
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: