Healthcare Provider Details

I. General information

NPI: 1043476096
Provider Name (Legal Business Name): FAYZ YAR KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10214 N TATUM BLVD STE B300
PHOENIX AZ
85028-4233
US

IV. Provider business mailing address

10214 N TATUM BLVD STE B300
PHOENIX AZ
85028-4233
US

V. Phone/Fax

Practice location:
  • Phone: 623-256-4160
  • Fax: 866-559-1305
Mailing address:
  • Phone: 623-256-4160
  • Fax: 866-559-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41841
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number41841
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: