Healthcare Provider Details

I. General information

NPI: 1790731115
Provider Name (Legal Business Name): SHEIK N KHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 GRAVELLY LAKE DR SW
LAKEWOOD WA
98499-5036
US

IV. Provider business mailing address

1019 PACIFIC AVE SUITE 300
TACOMA WA
98402-4443
US

V. Phone/Fax

Practice location:
  • Phone: 253-598-7030
  • Fax: 253-598-7033
Mailing address:
  • Phone: 253-597-4550
  • Fax: 253-722-1546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00041773
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: