Healthcare Provider Details

I. General information

NPI: 1316216831
Provider Name (Legal Business Name): SANJAYA KHANAL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43723 20TH ST W SUITE 101
LANCASTER CA
93534-4784
US

IV. Provider business mailing address

PO BOX 2030
LANCASTER CA
93539-2030
US

V. Phone/Fax

Practice location:
  • Phone: 661-674-4222
  • Fax: 661-674-4220
Mailing address:
  • Phone: 661-674-4222
  • Fax: 661-674-4220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA54074
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA54074
License Number StateCA

VIII. Authorized Official

Name: SANJAYA KHANAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-726-9500