Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | C52516 | CA |
NPI | 1013962885 |
---|---|
Provider Name | Deven Khosla |
First Address | Santa Monica, CA 90403-4809 |
Second Address | Santa Monica, CA 90403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016819 | (05) | NV |
880167036A004 | TRICARE (01) | NV |
CC3105 | BLUE CROSS BLUE SHIELD (01) | NV |
H39870 | (02) | NV |
XPY195323 | (05) | CA |