Provider Demographics
NPI:1316176894
Name:KHAN, AYESHA N (DO)
Entity type:Individual
Prefix:
First Name:AYESHA
Middle Name:N
Last Name:KHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 TOWNE CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1280
Mailing Address - Country:US
Mailing Address - Phone:817-306-5630
Mailing Address - Fax:817-306-5631
Practice Address - Street 1:833 TOWNE CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1280
Practice Address - Country:US
Practice Address - Phone:817-306-5630
Practice Address - Fax:817-306-5631
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6656207Q00000X, 207Q00000X
VA0102203162207Q00000X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325064901Medicaid
TXP01259020OtherMEDICARE RAILROAD
TXP01259020OtherMEDICARE RAILROAD
TX306057YNGSMedicare PIN
NCNC7581FMedicare PIN