Provider Demographics
NPI:1174106892
Name:KHANNA, HIMANSHU KRISHAN (MD)
Entity type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:KRISHAN
Last Name:KHANNA
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 1:175 W PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4168
Mailing Address - Country:US
Mailing Address - Phone:321-207-0172
Mailing Address - Fax:321-207-0175
Practice Address - Street 1:5717 RED BUG LAKE RD # 341
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4957
Practice Address - Country:US
Practice Address - Phone:321-207-0172
Practice Address - Fax:321-207-0175
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME169480207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine