Healthcare Provider Details

I. General information

NPI: 1508662008
Provider Name (Legal Business Name): KANWAL KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 7TH ST
BROOKLYN NY
11215-3311
US

IV. Provider business mailing address

326 7TH ST
BROOKLYN NY
11215-3311
US

V. Phone/Fax

Practice location:
  • Phone: 718-965-1234
  • Fax: 608-888-1790
Mailing address:
  • Phone: 718-965-1234
  • Fax: 608-888-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: