Healthcare Provider Details

I. General information

NPI: 1326063801
Provider Name (Legal Business Name): SANJAY NATVERLAL KHEDIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N 3RD AVE STE 100
COVINA CA
91723-1901
US

IV. Provider business mailing address

PO BOX 4869
WEST COVINA CA
91791-0869
US

V. Phone/Fax

Practice location:
  • Phone: 626-915-7674
  • Fax: 626-966-1952
Mailing address:
  • Phone: 626-915-7674
  • Fax: 626-966-1952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA56166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: