MEDICARE: DR. DEEPIKA KHANNA DMD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1780931097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEEPIKA KHANNA DMD

Provider Business Mailing Address
First Line	:	3450 WAYNE AVENUE
Second Line	:	APT 17B
City	:	BRONX
State	:	NY
Zip	:	10467-2510
Country	:	US
Telephone Number	:	617-901-9401
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 WAYNE AVE
Second Line	:	APT 17B
City	:	BRONX
State	:	NY
Zip	:	10467-2510
Country	:	US
Telephone Number	:	617-901-9401
Fax Number	:

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

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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