Provider Demographics
NPI:1700192838
Name:KHINVASARA, SONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SONA
Middle Name:
Last Name:KHINVASARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 WINCHESTER BLVD
Mailing Address - Street 2:#205
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0519
Mailing Address - Country:US
Mailing Address - Phone:408-374-1973
Mailing Address - Fax:
Practice Address - Street 1:1580 WINCHESTER BLVD
Practice Address - Street 2:#205
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0519
Practice Address - Country:US
Practice Address - Phone:408-374-1973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA471351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice