Provider Demographics
NPI:1063455475
Name:KHAN, NIVA (MD)
Entity Type:Individual
Prefix:
First Name:NIVA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIVA
Other - Middle Name:
Other - Last Name:KHAN-MIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-781-2210
Mailing Address - Fax:859-781-0289
Practice Address - Street 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071-3290
Practice Address - Country:US
Practice Address - Phone:859-781-2210
Practice Address - Fax:859-781-0289
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64079825Medicaid
OH2519046Medicaid
KYP00162935OtherRAILROAD MEDICARE
KYP00840873OtherRAILROAD MEDICARE
KYP00840873OtherRAILROAD MEDICARE
KYI08116Medicare UPIN
KY0387547Medicare PIN