Provider Demographics
NPI:1144518994
Name:XENON ANESTHESIA OF TEXAS PLLC
Entity type:Organization
Organization Name:XENON ANESTHESIA OF TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUJTABA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI-KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:281-408-4108
Mailing Address - Street 1:27 N ARROW CANYON CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2630
Mailing Address - Country:US
Mailing Address - Phone:281-408-4108
Mailing Address - Fax:281-408-4108
Practice Address - Street 1:2211 CLARK LN
Practice Address - Street 2:UNIT B
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4303
Practice Address - Country:US
Practice Address - Phone:917-621-6854
Practice Address - Fax:646-304-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3450207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty