Healthcare Provider Details

I. General information

NPI: 1053548644
Provider Name (Legal Business Name): SUNIEL S. KHEMLANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11398 KENYON WAY STE J
RANCHO CUCAMONGA CA
91701-9229
US

IV. Provider business mailing address

14071 PEYTON DR UNIT 2456
CHINO HILLS CA
91709-7209
US

V. Phone/Fax

Practice location:
  • Phone: 818-620-6193
  • Fax:
Mailing address:
  • Phone: 818-620-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA121065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: