1508852716 NPI number — AMANDEEP S KHURANA M.D.

Table of content: AMANDEEP S KHURANA M.D. (NPI 1508852716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508852716 NPI number — AMANDEEP S KHURANA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHURANA
Provider First Name:
AMANDEEP
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508852716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2149 E WARNER RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-3494
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-610-6100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
337 E CORONADO RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85004-1580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-252-8081
Provider Business Practice Location Address Fax Number:
602-252-1520
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  34131 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 947765 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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