Provider Demographics
NPI:1770583601
Name:KHOSLA, RAJAN (MD)
Entity type:Individual
Prefix:DR
First Name:RAJAN
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 1:11225 N 28TH DR STE B210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5610
Mailing Address - Country:US
Mailing Address - Phone:480-699-2996
Mailing Address - Fax:480-361-6917
Practice Address - Street 1:950 N MCQUEEN RD STE 100
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-8126
Practice Address - Country:US
Practice Address - Phone:480-542-7000
Practice Address - Fax:480-542-7500
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32972207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ100580OtherMEDICARE PIN
AZ2Z1750OtherHEALTHNET
AZ523440Medicaid
AZAZ0766700OtherBCBS
G61760Medicare UPIN