Provider Demographics
NPI:1609079722
Name:KHOSLA, DHIRA (DO)
Entity Type:Individual
Prefix:
First Name:DHIRA
Middle Name:
Last Name:KHOSLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 OAK GROVE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4351
Mailing Address - Country:US
Mailing Address - Phone:650-324-0700
Mailing Address - Fax:650-324-0709
Practice Address - Street 1:695 OAK GROVE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4351
Practice Address - Country:US
Practice Address - Phone:650-324-0700
Practice Address - Fax:650-324-0709
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A94502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology