Provider Demographics
NPI:1316216831
Name:SANJAYA KHANAL, M.D., INC.
Entity Type:Organization
Organization Name:SANJAYA KHANAL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-726-9500
Mailing Address - Street 1:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2030
Mailing Address - Country:US
Mailing Address - Phone:661-674-4222
Mailing Address - Fax:661-674-4220
Practice Address - Street 1:43723 20TH ST W
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4784
Practice Address - Country:US
Practice Address - Phone:661-674-4222
Practice Address - Fax:661-674-4220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54074207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare PIN