Provider Demographics
NPI:1295724524
Name:KHANNA, SANJEEV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:KHANNA
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 1:1112 E WEISGARBER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2647
Mailing Address - Country:US
Mailing Address - Phone:865-558-9862
Mailing Address - Fax:865-584-3478
Practice Address - Street 1:1112 E WEISGARBER RD STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2647
Practice Address - Country:US
Practice Address - Phone:865-558-9862
Practice Address - Fax:865-584-3478
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350868742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2599004Medicaid
CA1295724524Medicaid
TNQ080253Medicaid
CA0A1000410Medicare PIN
CAWA100041CMedicare PIN
CA1295724524Medicaid
I07919Medicare UPIN
CAWA100041AMedicare PIN