Healthcare Provider Details

I. General information

NPI: 1073584611
Provider Name (Legal Business Name): FARHA N KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W BUCKEYE RD SUITE 402
PHOENIX AZ
85003-2647
US

IV. Provider business mailing address

515 W BUCKEYE RD SUITE 402
PHOENIX AZ
85003-2647
US

V. Phone/Fax

Practice location:
  • Phone: 480-759-1040
  • Fax: 480-759-3520
Mailing address:
  • Phone: 602-257-9229
  • Fax: 602-257-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25174
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: