Healthcare Provider Details

I. General information

NPI: 1699144477
Provider Name (Legal Business Name): JENNIFER KHAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

1129 SCOTT DR
VALLEY STREAM NY
11580-2155
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1265
  • Fax:
Mailing address:
  • Phone: 631-208-6236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3999219
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: