=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942838958
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AWAB UMAR KHAN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2020
-----------------------------------------------------
Last Update Date | 06/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11920 ASTORIA BLVD STE 320
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77089-6097
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-484-9369
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1505 W SHERMAN AVE
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-7059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-641-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | V9041
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------