Healthcare Provider Details

I. General information

NPI: 1629180310
Provider Name (Legal Business Name): RABIN KHETRAPAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 MOWRY AVE
FREMONT CA
94536-4115
US

IV. Provider business mailing address

734 MOWRY AVE
FREMONT CA
94536-4115
US

V. Phone/Fax

Practice location:
  • Phone: 510-742-6274
  • Fax: 510-742-6473
Mailing address:
  • Phone: 510-742-6274
  • Fax: 510-742-6473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA56137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: