Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 234650 | MA |
N | 111NI0900X | Internist | 234650 | MA |
Y | 207R00000X | Internist | Q2150 | TX |
Y | 111NI0900X | Internist | Q2150 | TX |
NPI | 1003086976 |
---|---|
Provider Name | Vandana Khera |
First Address | Sugar Land, TX 77479-4633 |
Second Address | Sugar Land, TX 77479-4633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2008 |
Last Update Date | 18/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356361101 | (05) | TX |
8FM737 | BLUE CROSS BLUE SHIELD (01) | TX |