| J. Khan, Llc | |
|
1739 E Beverly Ave Suite 221 Kingman AZ 86409-3593 | |
| (928) 681-8671 | |
| (928) 681-8672 |
| Full Name | J. Khan, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1739 E Beverly Ave, Kingman, Arizona |
| Authorized Official Name and Position | Jakulla Khan (OWNER) |
| Authorized Official Contact | 9286818671 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Khan, Llc 1739 E Beverly Ave Suite 221 Kingman AZ 86409-3593 Ph: (928) 681-8671 | J. Khan, Llc 1739 E Beverly Ave Suite 221 Kingman AZ 86409-3593 Ph: (928) 681-8671 |
| NPI Number | 1003076712 |
|---|---|
| Provider Enumeration Date | 06/16/2008 |
| Last Update Date | 03/07/2023 |
| Medicare PECOS PAC ID | 3274606124 |
|---|---|
| Medicare Enrollment ID | O20080725000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003076712 | NPI | - | NPPES |
| 37755 | Other | AZ | AZ MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 37755 (Arizona) | Primary |
| Provider Name | Jakaulla J Khan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1306936349 PECOS PAC ID: 9032154927 Enrollment ID: I20080725000003 |
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