Provider Demographics
NPI:1629180310
Name:KHETRAPAL, RABIN (MD)
Entity Type:Individual
Prefix:
First Name:RABIN
Middle Name:
Last Name:KHETRAPAL
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 1:734 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4115
Mailing Address - Country:US
Mailing Address - Phone:510-742-6274
Mailing Address - Fax:510-742-6473
Practice Address - Street 1:734 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4115
Practice Address - Country:US
Practice Address - Phone:510-742-6274
Practice Address - Fax:510-742-6473
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110239879OtherRR MEDICARE
CA00A561370Medicaid
G 96667Medicare UPIN
CAOOA561370Medicare ID - Type Unspecified