Provider Demographics
NPI:1235319500
Name:KHANNA, GAURAV (MD)
Entity Type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:
Last Name:KHANNA
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 1:5585 SHANNON RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-4810
Mailing Address - Country:US
Mailing Address - Phone:443-824-3660
Mailing Address - Fax:858-650-5039
Practice Address - Street 1:8008 FROST ST STE 401
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4209
Practice Address - Country:US
Practice Address - Phone:858-650-5036
Practice Address - Fax:858-650-5039
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089734207R00000X
OH35.089734207RC0200X, 207RP1001X
CAC167024207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.089734OtherSTATE LICENSE
CAC167024OtherSTATE LICENSE