Healthcare Provider Details

I. General information

NPI: 1760721310
Provider Name (Legal Business Name): KHEMKA AND KHEMKA M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE SUITE 410
ANAHEIM CA
92801-2863
US

IV. Provider business mailing address

1211 W LA PALMA AVE SUITE 410
ANAHEIM CA
92801-2863
US

V. Phone/Fax

Practice location:
  • Phone: 714-956-7231
  • Fax: 714-758-9676
Mailing address:
  • Phone: 714-956-7231
  • Fax: 714-758-9676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA25263
License Number StateCA

VIII. Authorized Official

Name: JUDTH BAHENA
Title or Position: MANAGER
Credential:
Phone: 714-956-7231