Healthcare Provider Details

I. General information

NPI: 1891938783
Provider Name (Legal Business Name): PINKY KHATRI AUD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PINKY RAJU

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST SUITE 303
MC LEAN VA
22101-6007
US

IV. Provider business mailing address

14102 SULLYFIELD CIR STE 350C
CHANTILLY VA
20151-1672
US

V. Phone/Fax

Practice location:
  • Phone: 703-448-0005
  • Fax: 703-448-0808
Mailing address:
  • Phone: 703-988-6767
  • Fax: 703-988-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number22101001462
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: