Healthcare Provider Details

I. General information

NPI: 1629431374
Provider Name (Legal Business Name): TAHIR KHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 DANA AVE
CINCINNATI OH
45207-1340
US

IV. Provider business mailing address

3868 MCMANN RD
CINCINNATI OH
45245-2306
US

V. Phone/Fax

Practice location:
  • Phone: 513-601-0600
  • Fax:
Mailing address:
  • Phone: 513-843-7632
  • Fax: 513-718-3223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.136408
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: