Provider Demographics
NPI:1013962885
Name:KHOSLA, DEVEN (MD)
Entity type:Individual
Prefix:
First Name:DEVEN
Middle Name:
Last Name:KHOSLA
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 1:2811 WILSHIRE BLVD STE 950
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4809
Mailing Address - Country:US
Mailing Address - Phone:775-530-9669
Mailing Address - Fax:
Practice Address - Street 1:2811 WILSHIRE BLVD STE 950
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4809
Practice Address - Country:US
Practice Address - Phone:775-530-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52516207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXPY195323Medicaid
NV880167036A004OtherTRICARE
NVCC3105OtherBLUE CROSS BLUE SHIELD
NV002016819Medicaid
NVCC3105OtherBLUE CROSS BLUE SHIELD
NVH39870Medicare UPIN
NV002016819Medicaid