Active NPI
Fowzia Jasim Khan, PSY.D.
- Psychologist
- Chicago, IL
National Provider Identifier
1912169798
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 071.007091
- Practice address
- 30 N Michigan Ave
Suite 1920
Chicago, IL 60602-3402 - Phone
- (773) 294-1576
- NPI assigned
- Jul 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 071.007091 | IL | Primary |
Addresses
Primary practice location
30 N Michigan Ave
Suite 1920
Chicago, IL 60602-3402
Mailing address
5617 S Dorchester Ave
Apartment 7 N
Chicago, IL 60637-1749
Phone (773) 294-1576
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 071.007091 | IL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214956800000",
"number": "1912169798",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5617 S DORCHESTER AVE",
"address_2": "APARTMENT 7 N",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371749",
"telephone_number": "773-294-1576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 N MICHIGAN AVE",
"address_2": "SUITE 1920",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606023402",
"telephone_number": "773-294-1576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "FOWZIA",
"middle_name": "JASIM",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-02",
"last_updated": "2008-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "IL",
"license": "071.007091",
"primary": true
}
],
"identifiers": [],
"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 Jul 2, 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.