Provider Demographics
NPI:1316527039
Name:KHAWAJA, FATEN
Entity type:Individual
Prefix:
First Name:FATEN
Middle Name:
Last Name:KHAWAJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21401 PROVINCIAL BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450
Mailing Address - Country:US
Mailing Address - Phone:281-520-4016
Mailing Address - Fax:832-375-1247
Practice Address - Street 1:21401 PROVINCIAL BLVD
Practice Address - Street 2:STE A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450
Practice Address - Country:US
Practice Address - Phone:281-520-4016
Practice Address - Fax:832-375-1247
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4555213ES0103X
TX692127213ES0103X, 213E00000X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program