Provider Demographics
NPI:1215099379
Name:KHAWAJA, HASAN S (MD)
Entity type:Individual
Prefix:DR
First Name:HASAN
Middle Name:S
Last Name:KHAWAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3298
Mailing Address - Fax:702-667-4689
Practice Address - Street 1:2450 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2179
Practice Address - Country:US
Practice Address - Phone:702-579-3298
Practice Address - Fax:702-667-4689
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95682207L00000X
NV12711207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1215099379Medicaid
HI630154OtherHAWAII
NVV113969OtherPAC MEDICARE
AZ365712Medicaid
ID808469200Medicaid
NVV113969OtherPAC MEDICARE