Individual provider Active NPI

Fadia K Habib-Khazen, MD

  • Allergy & Immunology Physician
  • Phoenix, AZ
National Provider Identifier
1063404531
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
22782 Issued in AZ
Practice address
4901 N 44TH St Ste 103
Phoenix, AZ 85018-2782
Phone
(602) 954-0405
Fax
(602) 954-0485
NPI assigned
Aug 19, 2005
Last updated
Apr 5, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X 22782 AZ Primary

Addresses

Primary practice location

4901 N 44TH St Ste 103
Phoenix, AZ 85018-2782

Mailing address

Dept. 453 PO Box 1000
Memphis, TN 38148-1934
Phone (828) 575-2625

Other identifiers 1

IdentifierTypeStateIssuer
007204MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
22782AZMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy Associates & Asthma, LTD Current Accepting new patients

Locations

4901 N 44th St
Ste 103
Phoenix, AZ 85018
Phone (602) 954-0405

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680652800000",
    "number": "1063404531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. 453 PO BOX 1000",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381481934",
            "telephone_number": "828-575-2625",
            "fax_number": "828-350-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 N 44TH ST STE 103",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850182782",
            "telephone_number": "602-954-0405",
            "fax_number": "602-954-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABIB-KHAZEN",
        "first_name": "FADIA",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "AZ",
            "license": "22782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007204",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.