Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 049662 | NY |
NPI | 1013030261 |
---|---|
Provider Name | Dr. Shafiulla Khan |
First Address | Elmhurst, NY 11373-5080 |
Second Address | Elmhurst, NY 11373-5080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02320703 | (05) | NY |