Healthcare Provider Details

I. General information

NPI: 1629725825
Provider Name (Legal Business Name): KASHIF KHAN LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 YARD ST
GRANDVIEW OH
43212-3886
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-5123
  • Fax: 614-293-4890
Mailing address:
  • Phone: 614-293-5123
  • Fax: 614-293-4890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI.2506976
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: