Provider Demographics
NPI:1659867257
Name:KHEMLANI, RAVI
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:
Last Name:KHEMLANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5674 STONERIDGE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8563
Mailing Address - Country:US
Mailing Address - Phone:925-399-1762
Mailing Address - Fax:
Practice Address - Street 1:5674 STONERIDGE DR STE 105
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8563
Practice Address - Country:US
Practice Address - Phone:925-551-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF8182238172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver