Provider Demographics
NPI:1477676286
Name:KHANNA, PANCHALI (MD)
Entity type:Individual
Prefix:DR
First Name:PANCHALI
Middle Name:
Last Name:KHANNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 E SPRUCE AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3379
Mailing Address - Country:US
Mailing Address - Phone:559-554-9442
Mailing Address - Fax:559-293-4969
Practice Address - Street 1:1243 E SPRUCE AVE
Practice Address - Street 2:STE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3379
Practice Address - Country:US
Practice Address - Phone:559-554-9442
Practice Address - Fax:559-293-4969
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083133207R00000X
CAA112116207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine