Basic Information
| Provider Information | |||||||||
| NPI: | 1215491162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | FARIYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7501 LITTLE RIVER TPKE | ||||||||
| Address2: | |||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220032997 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7501 LITTLE RIVER TPKE | ||||||||
| Address2: | |||||||||
| City: | ANNANDALE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035355568 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2019 | ||||||||
| LastUpdateDate: | 10/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1223G0001X | 0401416587 | VA | Y | Dental Providers | Dentist | General Practice |
No ID Information.