Basic Information
| Provider Information | |||||||||
| NPI: | 1003086976 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHERA | ||||||||
| FirstName: | VANDANA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18717 UNIVERSITY BLVD BLDG 2 | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812083322 | ||||||||
| FaxNumber: | 2812083393 | ||||||||
| Practice Location | |||||||||
| Address1: | 18717 UNIVERSITY BLVD BLDG 2 | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812083322 | ||||||||
| FaxNumber: | 2812083393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2008 | ||||||||
| LastUpdateDate: | 08/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 234650 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | Q2150 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 356361101 | 05 | TX | MEDICAID | 8FM737 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |