Healthcare Provider Details

I. General information

NPI: 1245490853
Provider Name (Legal Business Name): KINNARI PATEL KHATRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KINNARI BALDEV PATEL M.D.

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N BRAND BLVD FL 11
GLENDALE CA
91203-2638
US

IV. Provider business mailing address

PO BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 833-447-2775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN7291
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.123552
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number290325
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: