Provider Demographics
NPI:1942748686
Name:JOKHAN, OMAR
Entity type:Individual
Prefix:MR
First Name:OMAR
Middle Name:
Last Name:JOKHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 175TH ST
Mailing Address - Street 2:APT# LB3
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5731
Mailing Address - Country:US
Mailing Address - Phone:718-659-5640
Mailing Address - Fax:
Practice Address - Street 1:8720 175TH ST
Practice Address - Street 2:APT# LB3
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5731
Practice Address - Country:US
Practice Address - Phone:718-659-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable