Provider Demographics
NPI:1912411448
Name:KHANIJOW, RAGHAV
Entity type:Individual
Prefix:
First Name:RAGHAV
Middle Name:
Last Name:KHANIJOW
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RICKY
Other - Middle Name:
Other - Last Name:KHANIJOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:424 GUERRERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1015
Mailing Address - Country:US
Mailing Address - Phone:415-621-5661
Mailing Address - Fax:
Practice Address - Street 1:424 GUERRERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-621-5661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker