Basic Information
| Provider Information | |||||||||
| NPI: | 1104145481 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | RIZWAN | ||||||||
| MiddleName: | SAMI | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2810 CAMINO DEL RIO S STE 102 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192991419 | ||||||||
| FaxNumber: | 8584616008 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 W BOONE AVE | ||||||||
| Address2: | SUITE 757 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992012354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098680876 | ||||||||
| FaxNumber: | 5093850670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2010 | ||||||||
| LastUpdateDate: | 10/23/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA.PA.60139142 | WA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 54418 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.