Provider Demographics
NPI:1144208497
Name:KHURANA, MUKUL (MD)
Entity Type:Individual
Prefix:
First Name:MUKUL
Middle Name:
Last Name:KHURANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3875
Mailing Address - Country:US
Mailing Address - Phone:718-535-7927
Mailing Address - Fax:347-527-2988
Practice Address - Street 1:3029 38TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3875
Practice Address - Country:US
Practice Address - Phone:718-535-7927
Practice Address - Fax:347-527-2988
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA058975OtherGEORGIA LICENSE
GA888385704AMedicaid
GA888385704AMedicaid
GA11SCHDFMedicare PIN
H96668Medicare UPIN
GA511G700375OtherCMS GROUP NUMBER