MEDICARE: MALIHA KHAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019.032598	IL

General Provider Information

NPI Number	:	1013527043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIHA KHAN DMD

Provider Business Mailing Address
First Line	:	2729 W JEROME ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-1304
Country	:	US
Telephone Number	:	847-814-1831
Fax Number	:

Provider Business Practice Location Address
First Line	:	5961 N LINCOLN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3758
Country	:	US
Telephone Number	:	847-814-1831
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	08/04/2020

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