Provider Demographics
NPI:1124220157
Name:KHANNA, SURABHI AGARWAL (MD)
Entity type:Individual
Prefix:DR
First Name:SURABHI
Middle Name:AGARWAL
Last Name:KHANNA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 GENESEE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4989
Mailing Address - Country:US
Mailing Address - Phone:858-284-0070
Mailing Address - Fax:858-284-0071
Practice Address - Street 1:4282 GENESEE AVE STE 202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4989
Practice Address - Country:US
Practice Address - Phone:858-284-0070
Practice Address - Fax:858-284-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC171517207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100124300Medicaid
IN200985460Medicaid
OH3029092Medicaid
IN200985460Medicaid
OH3029092Medicaid