Healthcare Provider Details

I. General information

NPI: 1639134828
Provider Name (Legal Business Name): SHAHABUDDIN KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 N TENAYA WAY STE. 320
LAS VEGAS NV
89128-0443
US

IV. Provider business mailing address

700 E SILVERADO RANCH BLVD SUITE 170
LAS VEGAS NV
89183-7516
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-6482
  • Fax: 702-804-0957
Mailing address:
  • Phone: 702-240-6482
  • Fax: 702-804-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11499
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: