Active NPI
Mushtaq Ahmad Khan
- Dermatology Physician
- Sugar Land, TX
National Provider Identifier
1245232933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 35037786
- Practice address
- 1410 N Horseshoe Dr
Sugar Land, TX 77478-3417 - Phone
- (281) 302-5756
- Fax
- (281) 990-6356
- NPI assigned
- Aug 11, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 35037786 | OH | Primary |
Addresses
Primary practice location
1410 N Horseshoe Dr
Sugar Land, TX 77478-3417
Mailing address
1410 N Horseshoe Dr
Sugar Land, TX 77478-3417
Phone (281) 302-5756
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0350310 | Medicaid | OH |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 35037786 | OH | MD | Dermatology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Licking Memorial Professional Corporation | Past | Accepting new patients | |
| Licking Memorial Professional Corporation | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Newark, OH
- NPI 1932186053
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490054400000",
"number": "1245232933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1410 N HORSESHOE DR",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774783417",
"telephone_number": "281-302-5756",
"fax_number": "281-990-6356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1410 N HORSESHOE DR",
"city": "SUGAR LAND",
"state": "TX",
"postal_code": "774783417",
"telephone_number": "281-302-5756",
"fax_number": "281-990-6356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "MUSHTAQ",
"middle_name": "AHMAD",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-11",
"last_updated": "2017-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OH",
"license": "35037786",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0350310",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sugar Land, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.