Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS039059 | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS039059 | PA |
NPI | 1427217694 |
---|---|
Provider Name | Shachika Khanna |
First Address | Philadelphia, PA 19107-5211 |
Second Address | Philadelphia, PA 19107-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 23/08/2019 |