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General NPI Number Information
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NPI Number | 1265534382
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Entity Type | Organization
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Legal Business Name | SANDSTON PRIMARY CARE INC.
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 35 E WILLIAMSBURG RD
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City | SANDSTON
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State | VA
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Zip | 23150-2011
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Country | US
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Telephone | 804-737-7804
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Fax | 804-737-8973
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Provider Business Mailing Address
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Address Line | 35 E WILLIAMSBURG RD
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City | SANDSTON
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State | VA
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Zip | 23150-2011
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Country | US
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Telephone | 804-737-7804
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Fax | 804-737-8973
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. SHUJA U KHAN
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Credential | MD
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Telephone | 804-737-7804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0101053528
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License Number State | VA
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