Provider Demographics
NPI:1609060821
Name:KHAN, SUMAYYAH KHALID (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUMAYYAH
Middle Name:KHALID
Last Name:KHAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-4012
Mailing Address - Country:US
Mailing Address - Phone:312-498-6829
Mailing Address - Fax:
Practice Address - Street 1:28365 DAVIS PKWY STE 206
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-3034
Practice Address - Country:US
Practice Address - Phone:630-836-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist