Provider Demographics
NPI:1326115429
Name:KHEMKA, SUDHIR S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:S
Last Name:KHEMKA
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 1:4454 N DECATUR BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130
Mailing Address - Country:US
Mailing Address - Phone:702-880-4193
Mailing Address - Fax:702-880-4197
Practice Address - Street 1:4454 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130
Practice Address - Country:US
Practice Address - Phone:702-880-4193
Practice Address - Fax:702-880-4197
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13352207L00000X, 208VP0000X, 208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1579700Medicaid
TXP00606653OtherMEDICARE RAILROAD
TX191428501Medicaid
TX8AC776OtherBLUE CROSS BLUE SHIELD
TX8K3732Medicare PIN
LA1579700Medicaid
LAH81816Medicare UPIN