Healthcare Provider Details

I. General information

NPI: 1770422412
Provider Name (Legal Business Name): ATIYA KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

1885 EL PASEO ST APT 35404
HOUSTON TX
77054-3051
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-2156
  • Fax:
Mailing address:
  • Phone: 505-364-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: