Provider Demographics
NPI:1205456605
Name:KHAN, DULAL (QBHS)
Entity type:Individual
Prefix:
First Name:DULAL
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:QBHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5719 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7339
Mailing Address - Country:US
Mailing Address - Phone:440-533-5078
Mailing Address - Fax:
Practice Address - Street 1:5719 LAURA LN
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7339
Practice Address - Country:US
Practice Address - Phone:440-533-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator