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General NPI Number Information
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NPI Number | 1417563404
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Entity Type | Individual
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Provider Name | HUNNAAN MOHAMMED KHAN PA
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Gender | Male
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 2875 W 19TH ST
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City | CHICAGO
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State | IL
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Zip | 60623-3501
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Country | US
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Telephone | 773-484-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3909 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-3741
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Country | US
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Telephone | 773-739-9200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14271
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085.010251
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License Number State | IL
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