Healthcare Provider Details

I. General information

NPI: 1699878504
Provider Name (Legal Business Name): HIMAL B BAJRACHARYA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7255 RENNER RD STE 100
SHAWNEE KS
66217-3101
US

IV. Provider business mailing address

7255 RENNER RD STE 100
SHAWNEE KS
66217-3101
US

V. Phone/Fax

Practice location:
  • Phone: 913-631-0405
  • Fax: 913-631-0409
Mailing address:
  • Phone: 913-631-0405
  • Fax: 913-631-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number2009021564
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number04-28743
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: