Basic Information
Provider Information | |||||||||
NPI: | 1740302561 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KHAN | ||||||||
FirstName: | ASJAD | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12221 MERIT DRIVE, SUITE 1610 | ||||||||
Address2: | QUESTCARE PARTNERS | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 75251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2142171911 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1221 MERIT DRIVE, | ||||||||
Address2: | 1610 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 75251 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2142171911 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/04/2007 | ||||||||
LastUpdateDate: | 12/31/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 2007004402 | MO | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | P6655 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207R00000X | P6655 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 322281202 | 05 | TX |   | MEDICAID | 322281201 | 05 | TX |   | MEDICAID |