Healthcare Provider Details

I. General information

NPI: 1225684160
Provider Name (Legal Business Name): ABDUL KARIM KHAN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/06/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22201 MOROSS PROFESSIONAL BUILDING II, SUITE 155
DETROIT MI
48236
US

IV. Provider business mailing address

22201 MOROSS PROFESSIONAL BUILDING II, SUITE 155
DETROIT MI
48236
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number35679
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2901602514
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: