MEDICARE: MRS. KHUSHBU MALHOTRA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	193400000X	MA

General Provider Information

NPI Number	:	1114401304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KHUSHBU MALHOTRA

Provider Business Mailing Address
First Line	:	10615 YSAMY WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1659
Country	:	US
Telephone Number	:	617-834-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	5835 CULEBRA RD STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-4355
Country	:	US
Telephone Number	:	210-988-0777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/11/2025

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