Organization Active NPI

Nasreen Khan M D S C

  • Primary Care Clinic/Center
  • Chicago, IL
National Provider Identifier
1720304249
Registry record updated Sep 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
3656673 Issued in IL
Legal business name
NASREEN KHAN M D S C
Practice address
4633 N Clark St
Chicago, IL 60640-4619
Phone
(773) 275-7500
Fax
(773) 275-0449
NPI assigned
Apr 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2010

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

Authorized official

Name
Dr. Nasreen Khan, MD
Title
Owner
Phone
(773) 275-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 3656673 IL Primary

Addresses

Primary practice location

4633 N Clark St
Chicago, IL 60640-4619

Mailing address

4633 N Clark St
Chicago, IL 60640-4619
Phone (773) 275-7500

Other identifiers 1

IdentifierTypeStateIssuer
036056673MedicaidIL

National Provider Directory

National Provider Directory

Locations

4633 N Clark St
#1
Chicago, IL 60640
Phone (773) 275-7500

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285718400000",
    "number": "1720304249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4633 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404619",
            "telephone_number": "773-275-7500",
            "fax_number": "773-275-0449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4633 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404619",
            "telephone_number": "773-275-7500",
            "fax_number": "773-275-0449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NASREEN KHAN M D S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-08",
        "last_updated": "2010-09-29",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "NASREEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "773-275-7500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "IL",
            "license": "3656673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036056673",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.