Provider Demographics
NPI:1912941956
Name:KHILNANI, HARESH M (MD)
Entity Type:Individual
Prefix:DR
First Name:HARESH
Middle Name:M
Last Name:KHILNANI
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 1:717 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-1940
Mailing Address - Country:US
Mailing Address - Phone:626-357-9805
Mailing Address - Fax:626-357-4480
Practice Address - Street 1:51 N 5TH AVE # 302
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3710
Practice Address - Country:US
Practice Address - Phone:626-256-1000
Practice Address - Fax:626-256-1001
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50550207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF80596Medicare UPIN