Basic Information
| Provider Information | |||||||||
| NPI: | 1770100224 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAZI | ||||||||
| FirstName: | ZAIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738827901 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 HOSPITAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738827901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2020 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2020019363 | MO | N | Allopathic & Osteopathic Physicians | Surgery | 2085R0202X | 2021023806 | MO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 2020019363 | 01 | MO | MO BOARD OF HEALING ARTS | OTHER |