Healthcare Provider Details

I. General information

NPI: 1255880548
Provider Name (Legal Business Name): JOYTI K KHOKHAR MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 500
RICHMOND VA
23226-1928
US

IV. Provider business mailing address

PO BOX 936952
ATLANTA GA
31193-6952
US

V. Phone/Fax

Practice location:
  • Phone: 804-297-3055
  • Fax: 804-297-3056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0139000104
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: