Healthcare Provider Details

I. General information

NPI: 1174485783
Provider Name (Legal Business Name): KHAN PHYSICIAN SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14812 LOST FALLS WAY
OKLAHOMA CITY OK
73142-8505
US

IV. Provider business mailing address

14812 LOST FALLS WAY
OKLAHOMA CITY OK
73142-8505
US

V. Phone/Fax

Practice location:
  • Phone: 860-918-6024
  • Fax: 305-845-7394
Mailing address:
  • Phone: 860-918-6024
  • Fax: 305-845-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. AWAAD KHAN
Title or Position: MD/PRESIDENT
Credential: MD
Phone: 860-918-6024