Healthcare Provider Details

I. General information

NPI: 1932315769
Provider Name (Legal Business Name): SADIA M HAYAT KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MAPLE AVE W STE H
VIENNA VA
22180-4309
US

IV. Provider business mailing address

311 MAPLE AVE W STE H
VIENNA VA
22180-4309
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-5660
  • Fax:
Mailing address:
  • Phone: 703-938-5660
  • Fax: 703-242-8712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2004035766
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number0434939
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101273481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: