Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 35076082 | OH |
NPI | 1043364656 |
---|---|
Provider Name | Dr. Sanjiv K Khullar |
First Address | Canton, OH 44718-3506 |
Second Address | Canton, OH 44718-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 12/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000126859 | ANTHEM (01) | |
0400049 | UNITED HEALTHCARE (01) | |
100013229 | RAILROAD MEDICARE (01) | |
100238 | KAISER (01) | |
2177960 | (05) | OH |
2217260 | AETNA (01) | |
F99581 | (02) |