Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 0415683 | KS |
NPI | 1013914795 |
---|---|
Provider Name | Dr. Gyanchand J Khicha |
First Address | Wichita, KS 67214-4923 |
Second Address | Wichita, KS 67226-2022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100093090B | (05) | KS |
B69001 | (02) | KS |