Provider Demographics
NPI:1871755082
Name:KHAN, JASMINE RAFEEK (MD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:RAFEEK
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:128 VISION PARK BLVD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3017
Mailing Address - Country:US
Mailing Address - Phone:281-606-5355
Mailing Address - Fax:844-684-4234
Practice Address - Street 1:128 VISION PARK BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3017
Practice Address - Country:US
Practice Address - Phone:281-606-5355
Practice Address - Fax:844-684-4234
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN7574207RC0000X
PAMD438116207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX552633ZX7QMedicare PIN