Provider Demographics
NPI:1295826790
Name:KHEMKA, PANKAJ M (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:M
Last Name:KHEMKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:480 N CHANDLER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-4504
Mailing Address - Country:US
Mailing Address - Phone:714-288-8887
Mailing Address - Fax:714-758-2927
Practice Address - Street 1:1211 W LA PALMA AVE STE 410
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2806
Practice Address - Country:US
Practice Address - Phone:714-288-8887
Practice Address - Fax:714-758-2927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75135207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G751350Medicaid
CAG24934Medicare UPIN