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1659358596

NPI Code Detail

MEDICARE: KIMBERLY COOK KHOSLA MD

MEDICARE: KIMBERLY COOK KHOSLA 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	208000000X	Pediatrics Physician	35073226	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000360983	OTHER		ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	522374873030	OTHER		CARESOURCE
4	D7322604	OTHER		HUMANA
5	11443924	OTHER		CAQH#
6	7956655	OTHER		AETNA
7	1205294	OTHER		UHC

General Provider Information

NPI Number	:	1659358596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY COOK KHOSLA MD

Provider Business Mailing Address
First Line	:	PO BOX 933432
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-3555
Fax Number	:	937-641-4528

Provider Business Practice Location Address
First Line	:	1010 VALLEY ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-2070
Country	:	US
Telephone Number	:	937-641-4000
Fax Number	:	937-641-4500

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	12/31/2024

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Directions to “ KIMBERLY COOK KHOSLA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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