Provider Demographics
NPI:1982803524
Name:PANDYA, KHYATI (MD)
Entity type:Individual
Prefix:
First Name:KHYATI
Middle Name:
Last Name:PANDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 BRISTOL ST STE 150
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3068
Mailing Address - Country:US
Mailing Address - Phone:714-445-0228
Mailing Address - Fax:
Practice Address - Street 1:24022 CALLE DE LA PLATA STE 500
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7612
Practice Address - Country:US
Practice Address - Phone:877-430-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS235292080P0202X
OH35-096525208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3119940Medicaid
MS04523542Medicaid
LA2406761Medicaid
OHPA4308811Medicare PIN
MS04523542Medicaid