Healthcare Provider Details

I. General information

NPI: 1144424854
Provider Name (Legal Business Name): YASMIN JEANNE KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 HYLAND GREENS DR
BLOOMINGTON MN
55437-3934
US

IV. Provider business mailing address

2136 NILES AVE
SAINT PAUL MN
55116-1140
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18797
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: