Provider Demographics
NPI:1457718520
Name:PRERNA MONA KHANNA MD PC
Entity Type:Organization
Organization Name:PRERNA MONA KHANNA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:PRERNA
Authorized Official - Middle Name:MONA
Authorized Official - Last Name:KHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:214-629-0339
Mailing Address - Street 1:80254 JASPER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-0821
Mailing Address - Country:US
Mailing Address - Phone:214-629-0339
Mailing Address - Fax:209-579-5637
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:STE W200
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4800
Practice Address - Country:US
Practice Address - Phone:214-629-0339
Practice Address - Fax:209-579-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty