MEDICARE: DR. VIJAY P KHATRI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086X0206X	Surgical Oncology Physician	A68492	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A68492	OTHER	CA	CA MEDICAL LICENSE

General Provider Information

NPI Number	:	1003899642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAY P KHATRI M.D.

Provider Business Mailing Address
First Line	:	4501 X ST
Second Line	:	UC DAVIS CANCER CENTER, SUITE 3010
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2229
Country	:	US
Telephone Number	:	916-734-2172
Fax Number	:	916-731-5706

Provider Business Practice Location Address
First Line	:	4501 X ST
Second Line	:	UC DAVIS CANCER CENTER, SUITE 3010
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2229
Country	:	US
Telephone Number	:	916-734-2172
Fax Number	:	916-731-5706

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. VIJAY P KHATRI M.D.” Practice Location

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