Provider Demographics
NPI:1225898398
Name:MOIN, KHONDKER FARHANA (MD)
Entity type:Individual
Prefix:DR
First Name:KHONDKER FARHANA
Middle Name:
Last Name:MOIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9734 E 73RD ST APT 510
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3226
Mailing Address - Country:US
Mailing Address - Phone:405-780-3942
Mailing Address - Fax:
Practice Address - Street 1:1400 S COULTER ST STE 2500
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9100
Practice Address - Fax:806-354-5717
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP127561207R00000X
TXBP10089351390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine