MEDICARE: HERKANWAL S. KHAIRA MD

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	208800000X	Urology Physician	A95113	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073691564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HERKANWAL S. KHAIRA MD

Provider Business Mailing Address
First Line	:	1860 PENNSYLVANIA AVE STE 200
Second Line	:	200
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3550
Country	:	US
Telephone Number	:	707-646-4180
Fax Number	:	707-646-4181

Provider Business Practice Location Address
First Line	:	1860 PENNSYLVANIA AVE STE 200
Second Line	:	200
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-3550
Country	:	US
Telephone Number	:	707-646-4180
Fax Number	:	707-646-4181

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/13/2015

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