Healthcare Provider Details

I. General information

NPI: 1598991788
Provider Name (Legal Business Name): AMITA R KHAZANIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 CALIFORNIA ST STE 203
SAN FRANCISCO CA
94118-1892
US

IV. Provider business mailing address

130 SUTTER ST FL 2
SAN FRANCISCO CA
94104-4009
US

V. Phone/Fax

Practice location:
  • Phone: 415-593-1134
  • Fax:
Mailing address:
  • Phone: 415-658-6791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: