Provider Demographics
NPI:1366514044
Name:KHANNA, SANDEEP K (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:K
Last Name:KHANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2469
Mailing Address - Country:US
Mailing Address - Phone:323-526-7273
Mailing Address - Fax:323-526-7235
Practice Address - Street 1:1700 E CESAR E CHAVEZ AVE STE 3400
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2469
Practice Address - Country:US
Practice Address - Phone:323-526-7273
Practice Address - Fax:323-526-7235
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48969207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG77360Medicare UPIN