Healthcare Provider Details

I. General information

NPI: 1265534382
Provider Name (Legal Business Name): SANDSTON PRIMARY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E WILLIAMSBURG RD
SANDSTON VA
23150-2011
US

IV. Provider business mailing address

35 E WILLIAMSBURG RD
SANDSTON VA
23150-2011
US

V. Phone/Fax

Practice location:
  • Phone: 804-737-7804
  • Fax: 804-737-8973
Mailing address:
  • Phone: 804-737-7804
  • Fax: 804-737-8973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number0101053528
License Number StateVA

VIII. Authorized Official

Name: DR. SHUJA U KHAN
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 804-737-7804