Provider Demographics
NPI:1598944332
Name:RAJESH KHANNA A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RAJESH KHANNA A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-734-8600
Mailing Address - Street 1:1820 FULLERTON AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3175
Mailing Address - Country:US
Mailing Address - Phone:951-734-8600
Mailing Address - Fax:951-734-2666
Practice Address - Street 1:1820 FULLERTON AVE STE 310
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3175
Practice Address - Country:US
Practice Address - Phone:951-734-8600
Practice Address - Fax:951-734-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78474207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH60452Medicare UPIN
CAW17273Medicare PIN