Healthcare Provider Details

I. General information

NPI: 1952970493
Provider Name (Legal Business Name): HUSNA KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIFFANY PT STE 205
BLOOMINGDALE IL
60108-2916
US

IV. Provider business mailing address

1 TIFFANY PT STE 205
BLOOMINGDALE IL
60108-2916
US

V. Phone/Fax

Practice location:
  • Phone: 630-359-0105
  • Fax: 630-523-9105
Mailing address:
  • Phone: 630-751-9716
  • Fax: 630-523-9105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.033212
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: