Healthcare Provider Details

I. General information

NPI: 1043409873
Provider Name (Legal Business Name): FAIZUDDIN KHAJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 READING RD SUITE 330
CINCINNATI OH
45202-1461
US

IV. Provider business mailing address

2865 CHANCELLOR DR STE 215
CRESTVIEW HILLS KY
41017-3931
US

V. Phone/Fax

Practice location:
  • Phone: 513-381-1900
  • Fax: 513-287-6403
Mailing address:
  • Phone: 859-581-7120
  • Fax: 859-581-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.097073
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number44434
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number35.097073
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number44434
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: