Healthcare Provider Details

I. General information

NPI: 1306692306
Provider Name (Legal Business Name): ANANYA VIVEK KHANNA MA, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 SANTIAGO ST
SAN FRANCISCO CA
94116-1526
US

IV. Provider business mailing address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: