Healthcare Provider Details

I. General information

NPI: 1093034704
Provider Name (Legal Business Name): EDINA JANICE KHAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTHRIDGE LN
LEXINGTON VA
24450
US

IV. Provider business mailing address

1839 SPRINGHILL RD
STAUNTON VA
24401-0000
US

V. Phone/Fax

Practice location:
  • Phone: 540-464-8700
  • Fax: 540-464-1323
Mailing address:
  • Phone: 609-231-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004926
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: