Healthcare Provider Details

I. General information

NPI: 1164597167
Provider Name (Legal Business Name): SHAHBAZ AMIR KHAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/12/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 WISCONSIN AVE NW
WASHINGTON DC
20016-2138
US

IV. Provider business mailing address

4228 WISCONSIN AVE NW
WASHINGTON DC
20016-2138
US

V. Phone/Fax

Practice location:
  • Phone: 202-885-5600
  • Fax:
Mailing address:
  • Phone: 202-885-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA100500
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD045835
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: