Basic Information
| Provider Information | |||||||||
| NPI: | 1669904033 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KHAN | ||||||||
| FirstName: | ZAMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5027 GLEN CANYON DR | ||||||||
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| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234623665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405397869 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1035 NIDER BLVD | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234598701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579538351 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 04/03/2017 | ||||||||
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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 | 1135000 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.