Basic Information
| Provider Information | |||||||||
| NPI: | 1679708234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHANAL | ||||||||
| FirstName: | KRISHNA | ||||||||
| MiddleName: | PRASAD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS MD CAQSM FAAFP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 VETERAN MEMORIAL DR | ||||||||
| Address2: | BUILDING # 163 | ||||||||
| City: | TEMPLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004232111 | ||||||||
| FaxNumber: | 2547430135 | ||||||||
| Practice Location | |||||||||
| Address1: | 2094 ALBANY POST RD | ||||||||
| Address2: | BUILDING # 3 | ||||||||
| City: | MONTROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105481454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147374400 | ||||||||
| FaxNumber: | 8454526516 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2009 | ||||||||
| LastUpdateDate: | 06/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39700 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QS0010X | 275691 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | A 121654 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 036.130459 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | S3832 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | S3832 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.