Healthcare Provider Details

I. General information

NPI: 1962591834
Provider Name (Legal Business Name): KHUSAL D MEHTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KHUSALDAS D MEHTA MD

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N VERMONT AVE
DINUBA CA
93618-1631
US

IV. Provider business mailing address

430 N VERMONT AVE
DINUBA CA
93618-1631
US

V. Phone/Fax

Practice location:
  • Phone: 559-591-1060
  • Fax: 559-591-1083
Mailing address:
  • Phone: 559-591-1060
  • Fax: 559-591-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number00A36047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: