Provider Demographics
NPI:1639697402
Name:KHOSLA, JAGJIT (MD)
Entity type:Individual
Prefix:DR
First Name:JAGJIT
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 1:800 STANTON L YOUNG BLVD,
Mailing Address - Street 2:AAT 5481
Mailing Address - City:OKC
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5018
Mailing Address - Country:US
Mailing Address - Phone:405-271-4742
Mailing Address - Fax:
Practice Address - Street 1:800 STANTON L YOUNG BLVD,
Practice Address - Street 2:AAT 5481
Practice Address - City:OKC
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-4742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37915207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease