Healthcare Provider Details

I. General information

NPI: 1467398115
Provider Name (Legal Business Name): KHAN PEDIATRIC DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S BROADWAY
YONKERS NY
10701-4006
US

IV. Provider business mailing address

600 NORTH AVE UNIT 313
NEW ROCHELLE NY
10801-2638
US

V. Phone/Fax

Practice location:
  • Phone: 914-378-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SAMIA KHAN
Title or Position: OWNER/MEMBER
Credential:
Phone: 201-983-8663