Healthcare Provider Details

I. General information

NPI: 1295826790
Provider Name (Legal Business Name): PANKAJ M KHEMKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 410
ANAHEIM CA
92801-2806
US

IV. Provider business mailing address

480 N CHANDLER RANCH RD
ORANGE CA
92869-4504
US

V. Phone/Fax

Practice location:
  • Phone: 714-288-8887
  • Fax: 714-758-2927
Mailing address:
  • Phone: 714-288-8887
  • Fax: 714-758-2927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG75135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: