Nina W Khazen, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036104073 Issued in IL

Practice address

3033 Ogden Ave
Ste 101
Lisle, IL 60532-1673

Phone

(630) 717-5700

Fax

(630) 717-0665

NPI assigned

Sep 7, 2005

Last updated

Oct 6, 2008By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223251200000",
    "number": "1861486722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3033 OGDEN AVE",
            "address_2": "STE 101",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321673",
            "telephone_number": "630-717-5700",
            "fax_number": "630-717-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3033 OGDEN AVE",
            "address_2": "STE 101",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321673",
            "telephone_number": "630-717-5700",
            "fax_number": "630-717-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAZEN",
        "first_name": "NINA",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-07",
        "last_updated": "2008-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036104073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104073",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ellen Kennelly, FNP
• Laura Elizabeth Kenter, M.S., A.T.C.
• Kett Counseling and Educational Services, LLC
• Asma Khalid, MD
• Omer N Khan, DMD
• Kids Above All Illinois
• Clare Kilbride, CF-SLP
• Hyundo Kim, PH.D.
• Steven Sun-Kyu Kim, OD
• William Kindrachuk, M.D.

• Internal Medicine Physician in Lisle, IL
• Providers in Lisle, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2008; 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.