Basic Information
| Provider Information | |||||||||
| NPI: | 1952398604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | YASIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1146 S. CEDAR CREST BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181037938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103669000 | ||||||||
| FaxNumber: | 6103669229 | ||||||||
| Practice Location | |||||||||
| Address1: | 1146 S. CEDAR CREST BLVD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181037938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103669000 | ||||||||
| FaxNumber: | 6103669229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MD040917Y | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 591182 | 05 | PA | MEDICAID |