Healthcare Provider Details

I. General information

NPI: 1578239356
Provider Name (Legal Business Name): SALAR KHAN CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

7728 YOSEMITE LN
PARKLAND FL
33067-2323
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax:
Mailing address:
  • Phone: 954-907-2093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: