Healthcare Provider Details

I. General information

NPI: 1922857705
Provider Name (Legal Business Name): KHYATI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 FAIRWAY DR
ROSEVILLE CA
95678-3588
US

IV. Provider business mailing address

4823 BLACK WALNUT DR
FOLSOM CA
95630-6024
US

V. Phone/Fax

Practice location:
  • Phone: 916-380-3866
  • Fax:
Mailing address:
  • Phone: 518-409-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.033916
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS112750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: