MEDICARE: IRFAN AZIZ KHAN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.022887	OH

General Provider Information

NPI Number	:	1285186932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRFAN AZIZ KHAN INC

Provider Business Mailing Address
First Line	:	885 W 3RD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 W 3RD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3106
Country	:	US
Telephone Number	:	614-505-7027
Fax Number	:

Authorized Official
Title or Position	:	TREATMENT COORDINATOR
Name	:	JESSICA BOWERSOCK
Credential	:
Telephone Number	:	614-505-7027

Provider Enumeration Date	:	10/28/2016
Last Update Date	:	10/28/2016

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