Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2012-00056 | NC |
N | 207K00000X | Allergist & Immunologist | 41230 | KY |
N | 207K00000X | Allergist & Immunologist | 51918 | WI |
NPI | 1063605293 |
---|---|
Provider Name | Sanjay J Khiani |
First Address | Charlotte, NC 28210-8508 |
Second Address | Charlotte, NC 28210-8508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 16/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000541483 | ANTHEM PIN (01) | KY |
200340800 | (05) | IN |
200874570 | (05) | IN |
35337600 | (05) | WI |
9454082 | AETNA PIN (01) | KY |