Healthcare Provider Details

I. General information

NPI: 1235014598
Provider Name (Legal Business Name): SUBHANMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3486A LYON PARK CT
WOODBRIDGE VA
22192-1022
US

IV. Provider business mailing address

3486A LYON PARK CT
WOODBRIDGE VA
22192-1022
US

V. Phone/Fax

Practice location:
  • Phone: 703-296-2805
  • Fax:
Mailing address:
  • Phone: 703-296-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD HAYAT KHAN
Title or Position: OWNER
Credential:
Phone: 703-296-2805