Healthcare Provider Details

I. General information

NPI: 1386805059
Provider Name (Legal Business Name): ASIF ALI KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 116TH AVE NE STE 500
BELLEVUE WA
98004
US

IV. Provider business mailing address

MS 315010 PO BOX 1947
SEATTLE WA
98111
US

V. Phone/Fax

Practice location:
  • Phone: 425-709-7055
  • Fax: 425-709-7066
Mailing address:
  • Phone: 425-467-3655
  • Fax: 352-331-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number56955
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME129406
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number56955
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD61003338
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: