Provider Demographics
NPI:1164251781
Name:JAHAN, CHOWDHURY SHAKHAWAT
Entity type:Individual
Prefix:
First Name:CHOWDHURY
Middle Name:SHAKHAWAT
Last Name:JAHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 120TH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3112
Mailing Address - Country:US
Mailing Address - Phone:516-503-9277
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2108
Practice Address - Country:US
Practice Address - Phone:516-656-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP127388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine