Healthcare Provider Details

I. General information

NPI: 1164985636
Provider Name (Legal Business Name): KAVISHA KHANUJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST FRNT 1
PHILADELPHIA PA
19107-4420
US

IV. Provider business mailing address

833 CHESTNUT ST FRNT 1
PHILADELPHIA PA
19107-4420
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1085
  • Fax: 215-955-5041
Mailing address:
  • Phone: 215-955-1085
  • Fax: 215-955-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD494389
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: