Safiyyah Mukarram Khan, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

125085601 Issued in IL

Practice address

102 S Hennepin Ave
Dixon, IL 61021

Phone

(815) 285-8520

Fax

(815) 285-8903

NPI assigned

May 6, 2025

Last updated

Sep 2, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756771200000",
    "number": "1285423038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE.",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "61021",
            "telephone_number": "815-285-8520",
            "fax_number": "815-285-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S HENNEPIN AVE",
            "city": "DIXON",
            "state": "IL",
            "postal_code": "61021",
            "telephone_number": "815-285-8520",
            "fax_number": "815-285-8903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAN",
        "first_name": "SAFIYYAH",
        "middle_name": "MUKARRAM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-05-06",
        "last_updated": "2025-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125085601",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Anne Kelly, BAMHP
• Stacie Kemp
• Jesse Paul Kent
• Stephanie Ann Kester
• Victoria Lynn Keyton, ANP-C
• Osmaan Abbas Khawaja, MD
• Kristen Marie Kingery
• Kyla Kinney, RBT
• Julie Lynn Kirchhoff
• Alissa Kirchner

• Family Medicine Physician in Dixon, IL
• Providers in Dixon, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.