Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | A68492 | CA |
NPI | 1003899642 |
---|---|
Provider Name | Dr. Vijay P Khatri |
First Address | Sacramento, CA 95817-2229 |
Second Address | Sacramento, CA 95817-2229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A68492 | CA MEDICAL LICENSE (01) | CA |
G91766 | (02) | CA |