Healthcare Provider Details

I. General information

NPI: 1720378003
Provider Name (Legal Business Name): OMAR KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE 301
LAS VEGAS NV
89128-4340
US

IV. Provider business mailing address

7455 W WASHINGTON AVE STE 301
LAS VEGAS NV
89128-4340
US

V. Phone/Fax

Practice location:
  • Phone: 877-562-5227
  • Fax: 702-938-9954
Mailing address:
  • Phone: 877-562-5227
  • Fax: 702-938-9954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17260
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: