Healthcare Provider Details

I. General information

NPI: 1063455475
Provider Name (Legal Business Name): NIVA KHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIVA KHAN-MIAN M.D.

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 ALEXANDRIA PIKE SUITE 300
SOUTHGATE KY
41071-3290
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-781-2210
  • Fax: 859-781-0289
Mailing address:
  • Phone: 859-781-2210
  • Fax: 859-781-0289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38761
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: