Provider Demographics
NPI:1952970493
Name:KHAN, HUSNA
Entity Type:Individual
Prefix:
First Name:HUSNA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 FOUNDERS POINTE N
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1459
Mailing Address - Country:US
Mailing Address - Phone:630-751-9716
Mailing Address - Fax:
Practice Address - Street 1:144 W ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-3504
Practice Address - Country:US
Practice Address - Phone:630-953-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-19
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0332121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice