Healthcare Provider Details

I. General information

NPI: 1083341226
Provider Name (Legal Business Name): UZMA A KHAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SE 164TH AVE STE 201
VANCOUVER WA
98683-9644
US

IV. Provider business mailing address

1405 SE 164TH AVE STE 201
VANCOUVER WA
98683-9644
US

V. Phone/Fax

Practice location:
  • Phone: 503-791-5379
  • Fax:
Mailing address:
  • Phone: 503-791-5379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET R MOSSMAN
Title or Position: CLINIC ADMINISTRATOR
Credential: FACMPE
Phone: 503-791-5379