Healthcare Provider Details

I. General information

NPI: 1366845257
Provider Name (Legal Business Name): DANIAL KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2014
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 SE 36TH ST STE 410
MERCER ISLAND WA
98040-3840
US

IV. Provider business mailing address

1912 32ND AVE S
SEATTLE WA
98144-4948
US

V. Phone/Fax

Practice location:
  • Phone: 206-275-3588
  • Fax:
Mailing address:
  • Phone: 360-359-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60514687
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN60367859
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: