MEDICARE: QALB KHAN M.D.

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	207R00000X	Internal Medicine Physician	MD461625	PA
2	207R00000X	Internal Medicine Physician	U6995	TX
3	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	U6995	TX
4	208M00000X	Hospitalist Physician	MD461625	PA
5	207RN0300X	Nephrology Physician	U6995	TX

General Provider Information

NPI Number	:	1104232925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QALB KHAN M.D.

Provider Business Mailing Address
First Line	:	5605 N MACARTHUR BLVD STE 740
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2626
Country	:	US
Telephone Number	:	214-960-5681
Fax Number	:	214-960-5681

Provider Business Practice Location Address
First Line	:	10611 GARLAND RD STE 105
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75218-2680
Country	:	US
Telephone Number	:	469-904-2020
Fax Number	:	469-904-2028

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

Provider Enumeration Date	:	07/02/2014
Last Update Date	:	04/30/2025

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