Provider Demographics
NPI:1225685043
Name:KHATWANI, KAMIYA (DMD)
Entity Type:Individual
Prefix:
First Name:KAMIYA
Middle Name:
Last Name:KHATWANI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KING ST UNIT 270
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-5457
Mailing Address - Country:US
Mailing Address - Phone:206-437-8403
Mailing Address - Fax:
Practice Address - Street 1:250 KING ST UNIT 270
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-5457
Practice Address - Country:US
Practice Address - Phone:206-437-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist