NPIMap

Organization Active NPI

Kassim a Khan MD PA

  • Ophthalmology Physician
  • Fort Worth, TX
National Provider Identifier
1710168729
Registry record updated Oct 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
H7171 Issued in TX
Legal business name
KASSIM A KHAN MD PA
Practice address
1001 12TH Ave
Suite 132
Fort Worth, TX 76104-3926
Phone
(817) 870-2010
Fax
(817) 870-2050
NPI assigned
Nov 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2009

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

Authorized official

Name
Dr. Kassim A Khan, M.D.
Title
Physician
Phone
(817) 870-2010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X H7171 TX Primary

Addresses

Primary practice location

1001 12TH Ave
Suite 132
Fort Worth, TX 76104-3926

Mailing address

1001 12TH Ave
Suite 132
Fort Worth, TX 76104-3926
Phone (817) 870-2010

National Provider Directory

National Provider Directory

Locations

1101 W Rosedale St
Ft Worth, TX 76104
Phone (817) 870-2010

NPI Registry JSON

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

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255392000000",
    "number": "1710168729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE",
            "address_2": "SUITE 132",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043926",
            "telephone_number": "817-870-2010",
            "fax_number": "817-870-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 12TH AVE",
            "address_2": "SUITE 132",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761043926",
            "telephone_number": "817-870-2010",
            "fax_number": "817-870-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KASSIM A KHAN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2009-10-13",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "KASSIM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "817-870-2010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "TX",
            "license": "H7171",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; 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.