Healthcare Provider Details

I. General information

NPI: 1982672150
Provider Name (Legal Business Name): ZAFRULLA KHAN D.D.S.M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 S JACKSON ST BROWN CANCER CENTER STE 127
LOUISVILLE KY
40202-3229
US

IV. Provider business mailing address

529 S JACKSON ST BROWN CANCER CENTER STE 127
LOUISVILLE KY
40202-3229
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5747
  • Fax: 502-852-6132
Mailing address:
  • Phone: 502-852-5747
  • Fax: 502-852-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5067
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number5067/500
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: