Provider Demographics
NPI:1437857745
Name:KHAN, KAMRAN (RD)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 GRAND AVENUE PKWY APT 3125
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-0033
Mailing Address - Country:US
Mailing Address - Phone:832-272-0760
Mailing Address - Fax:
Practice Address - Street 1:8700 MENCHACA RD STE 806
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5379
Practice Address - Country:US
Practice Address - Phone:512-953-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT87593133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered