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General NPI Number Information
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NPI Number | 1982672150
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Entity Type | Individual
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Provider Name | ZAFRULLA KHAN D.D.S.M.S.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 529 S JACKSON ST BROWN CANCER CENTER STE 127
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City | LOUISVILLE
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State | KY
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Zip | 40202-3229
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Country | US
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Telephone | 502-852-5747
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Fax | 502-852-6132
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Provider Business Mailing Address
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Address Line | 529 S JACKSON ST BROWN CANCER CENTER STE 127
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City | LOUISVILLE
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State | KY
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Zip | 40202-3229
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Country | US
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Telephone | 502-852-5747
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Fax | 502-852-6132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 5067
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 5067/500
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License Number State | KY
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