Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 40642 | AZ |
N | 207RX0202X | Medical Oncology | 40642 | AZ |
NPI | 1073792289 |
---|---|
Provider Name | Dr. Vivek Khemka |
First Address | Goodyear, AZ 85338-3007 |
Second Address | Goodyear, AZ 85338-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 14/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356959 | (05) | AZ |
P00625102 | RAILROAD MEDICARE (01) | AZ |