Provider Demographics
NPI:1104145481
Name:KHAN, RIZWAN SAMI (PA)
Entity type:Individual
Prefix:MR
First Name:RIZWAN
Middle Name:SAMI
Last Name:KHAN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2810 CAMINO DEL RIO S STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3819
Mailing Address - Country:US
Mailing Address - Phone:619-299-1419
Mailing Address - Fax:858-461-6008
Practice Address - Street 1:316 W BOONE AVE
Practice Address - Street 2:SUITE 757
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2354
Practice Address - Country:US
Practice Address - Phone:509-868-0876
Practice Address - Fax:509-385-0670
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2017-10-23
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Provider Licenses
StateLicense IDTaxonomies
WAPA.PA.60139142363A00000X
CA54418363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant