Healthcare Provider Details

I. General information

NPI: 1194907881
Provider Name (Legal Business Name): ASIF A KHAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 S NAPERVILLE RD SUITE 207
WHEATON IL
60189
US

IV. Provider business mailing address

1751 S NAPERVILLE RD SUITE 207
WHEATON IL
60189
US

V. Phone/Fax

Practice location:
  • Phone: 630-774-8316
  • Fax: 630-690-3353
Mailing address:
  • Phone: 630-774-8316
  • Fax: 630-690-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071005733
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: