Healthcare Provider Details

I. General information

NPI: 1295724524
Provider Name (Legal Business Name): SANJEEV KHANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

PO BOX 110
WORTHINGTON OH
43085-0110
US

V. Phone/Fax

Practice location:
  • Phone: 614-716-8351
  • Fax:
Mailing address:
  • Phone: 614-981-1340
  • Fax: 614-947-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35086874
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: