Healthcare Provider Details

I. General information

NPI: 1326705997
Provider Name (Legal Business Name): MIJA KHAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8994 E DESERT COVE AVE
SCOTTSDALE AZ
85260-7901
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267-0096
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-2040
  • Fax:
Mailing address:
  • Phone: 209-956-7725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY BOYER
Title or Position: AUTHORIZED
Credential:
Phone: 209-956-7732