MEDICARE: ANGELICA JEAN KHAN

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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1295622173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA JEAN KHAN

Provider Business Mailing Address
First Line	:	1314 W PASEWALK AVE APT 8
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-4854
Country	:	US
Telephone Number	:	402-454-5375
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 W PASEWALK AVE APT 8
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-4854
Country	:	US
Telephone Number	:	402-454-5375
Fax Number	:

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

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/23/2025

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Directions to “ ANGELICA JEAN KHAN ” Practice Location

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