Healthcare Provider Details

I. General information

NPI: 1962988535
Provider Name (Legal Business Name): LUNA KHANAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 MOONBOW PLZ
CORBIN KY
40701-8949
US

IV. Provider business mailing address

45 MOONBOW PLZ
CORBIN KY
40701-8949
US

V. Phone/Fax

Practice location:
  • Phone: 606-523-9010
  • Fax: 606-523-0028
Mailing address:
  • Phone: 606-523-9010
  • Fax: 606-523-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number58698
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: