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General NPI Number Information
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NPI Number | 1679590319
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Entity Type | Individual
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Provider Name | ANIL KHOSLA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 1617 N CALIFORNIA ST STE 2D
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City | STOCKTON
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State | CA
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Zip | 95204-6117
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Country | US
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Telephone | 209-933-9888
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Fax | 209-933-9988
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST STE 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 848-288-6935
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Fax | 732-790-0107
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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 | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 25MA11085100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD61156101
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA11085100
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License Number State | NJ
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