Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 20A10356 | CA |
NPI | 1407026420 |
---|---|
Provider Name | Qamar Khan |
First Address | South Jordan, UT 84095-8524 |
Second Address | South Jordan, UT 84095-8524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 12/02/2013 |