MEDICARE: KUBRA KHAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1609717297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KUBRA KHAN

Provider Business Mailing Address
First Line	:	6992 SW 39TH ST APT I105
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-2457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5835
Country	:	US
Telephone Number	:	786-828-7552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ KUBRA KHAN ” Practice Location

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