Healthcare Provider Details

I. General information

NPI: 1255259743
Provider Name (Legal Business Name): KHAN WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 METROPOLITAN AVE APT 1D
BRONX NY
10462-6850
US

IV. Provider business mailing address

1514 METROPOLITAN AVE APT 1D
BRONX NY
10462-6850
US

V. Phone/Fax

Practice location:
  • Phone: 718-690-1425
  • Fax:
Mailing address:
  • Phone: 718-690-1425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: TAUKIR KHAN
Title or Position: RN
Credential: RN
Phone: 718-690-1425