MEDICARE: DR. DANA K KHUTHAILA 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	208200000X	Plastic Surgery Physician	255932	NY

General Provider Information

NPI Number	:	1376857136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA K KHUTHAILA MD

Provider Business Mailing Address
First Line	:	30 CENTRAL PARK S
Second Line	:	RM 11B
City	:	NEW YORK
State	:	NY
Zip	:	10019-1648
Country	:	CA
Telephone Number	:	212-810-9052
Fax Number	:	212-750-2849

Provider Business Practice Location Address
First Line	:	830 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-2757
Country	:	US
Telephone Number	:	212-810-9052
Fax Number	:

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

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/29/2016

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