Healthcare Provider Details

I. General information

NPI: 1912511775
Provider Name (Legal Business Name): YAKOOT MUHAMMAD KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 03/06/2024
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MORRIS ST
CHARLESTON WV
25301-1326
US

IV. Provider business mailing address

400 ASSOCIATION DR STE 102
CHARLESTON WV
25311-1298
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5432
  • Fax:
Mailing address:
  • Phone: 304-388-0151
  • Fax: 304-388-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0026855
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number32505
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: