Healthcare Provider Details

I. General information

NPI: 1659217016
Provider Name (Legal Business Name): AISHA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTON IM RESIDENCY CLINIC 96 15TH ST. NW, SUITE 111
NORTON VA
24273
US

IV. Provider business mailing address

7956 ASHWOOD LN
IRVING TX
75063-1808
US

V. Phone/Fax

Practice location:
  • Phone: 276-439-1872
  • Fax: 276-439-1872
Mailing address:
  • Phone: 214-850-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: