Provider Demographics
NPI:1639191455
Name:KHANNA, GAYATRI (MD)
Entity Type:Individual
Prefix:
First Name:GAYATRI
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYATRI
Other - Middle Name:
Other - Last Name:BHATIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MS
Mailing Address - Street 1:1700 CALIFORNIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4586
Mailing Address - Country:US
Mailing Address - Phone:415-386-5388
Mailing Address - Fax:415-386-8406
Practice Address - Street 1:1700 CALIFORNIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4586
Practice Address - Country:US
Practice Address - Phone:415-386-5388
Practice Address - Fax:415-386-8406
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH13663Medicare UPIN
CA00A645770Medicare ID - Type Unspecified