Healthcare Provider Details

I. General information

NPI: 1700703162
Provider Name (Legal Business Name): AASIM MEHMOOD KHAN MCN, RD, LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 WESLEY STE A
PROSPER TX
75078-7913
US

IV. Provider business mailing address

353 BENTON AVE
FAIRVIEW TX
75069-6810
US

V. Phone/Fax

Practice location:
  • Phone: 469-300-1392
  • Fax: 469-545-0621
Mailing address:
  • Phone: 240-688-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT87661
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: