Healthcare Provider Details

I. General information

NPI: 1124220157
Provider Name (Legal Business Name): SURABHI AGARWAL KHANNA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 202
SAN DIEGO CA
92117-4989
US

IV. Provider business mailing address

4282 GENESEE AVE STE 202
SAN DIEGO CA
92117-4989
US

V. Phone/Fax

Practice location:
  • Phone: 858-284-0070
  • Fax: 858-284-0071
Mailing address:
  • Phone: 858-284-0070
  • Fax: 858-284-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC171517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: