Provider Demographics
NPI:1508583790
Name:KHOSLA DERMATOLOGY, INC.
Entity Type:Organization
Organization Name:KHOSLA DERMATOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:650-482-7546
Mailing Address - Street 1:100 ARCH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1381
Mailing Address - Country:US
Mailing Address - Phone:650-482-7546
Mailing Address - Fax:650-562-7481
Practice Address - Street 1:100 ARCH ST STE 1
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1381
Practice Address - Country:US
Practice Address - Phone:650-482-7546
Practice Address - Fax:650-562-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty