Basic Information
| Provider Information | |||||||||
| NPI: | 1043409873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAJA | ||||||||
| FirstName: | FAIZUDDIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2865 CHANCELLOR DR | ||||||||
| Address2: | STE 215 | ||||||||
| City: | CRESTVIEW HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595817120 | ||||||||
| FaxNumber: | 8595817207 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 READING RD | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133811900 | ||||||||
| FaxNumber: | 5132876403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 35.097073 | OH | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 44434 | KY | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0107X | 35.097073 | OH | N | 207WX0107X | 44434 | KY | N |
ID Information
| ID | Type | State | Issuer | Description | 7100170190 | 05 | KY | MEDICAID | 0050894 | 05 | OH | MEDICAID |