Provider Demographics
NPI:1578351516
Name:KHAN, KIRAN (RD)
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PONDER LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-6218
Mailing Address - Country:US
Mailing Address - Phone:718-839-3787
Mailing Address - Fax:
Practice Address - Street 1:14 PONDER LN
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-6218
Practice Address - Country:US
Practice Address - Phone:718-839-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered