Healthcare Provider Details

I. General information

NPI: 1376538579
Provider Name (Legal Business Name): ASHOK K KHANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12470 US ROUTE 60
ASHLAND KY
41102-9687
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-6300
  • Fax: 606-408-6647
Mailing address:
  • Phone: 606-408-9571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18093
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: