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General NPI Number Information
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NPI Number | 1639697402
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Entity Type | Individual
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Provider Name | JAGJIT KHOSLA MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 05/23/2021
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Provider Practice Location Address
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Address Line | 800 STANTON L YOUNG BLVD, AAT 5481
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City | OKC
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State | OK
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Zip | 73104
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Country | US
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Telephone | 405-271-4742
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Fax |
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Provider Business Mailing Address
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Address Line | 800 STANTON L YOUNG BLVD, AAT 5481
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City | OKC
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State | OK
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Zip | 73104-5018
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Country | US
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Telephone | 405-271-4742
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 37915
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License Number State | OK
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