Provider Demographics
NPI:1881653699
Name:KANJI, RAHIM (OD)
Entity Type:Individual
Prefix:DR
First Name:RAHIM
Middle Name:
Last Name:KANJI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 GLENN MITCHELL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0167
Mailing Address - Country:US
Mailing Address - Phone:757-368-3937
Mailing Address - Fax:757-516-7032
Practice Address - Street 1:1975 GLENN MITCHELL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0167
Practice Address - Country:US
Practice Address - Phone:757-368-3937
Practice Address - Fax:757-516-7032
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001467152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010156556Medicaid
VA010156556Medicaid
VAV04602Medicare UPIN
VA190001272Medicare ID - Type Unspecified