Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 31362 | AZ |
Y | 207RI0011X | Interventional Cardiology | 31362 | AZ |
NPI | 1093783953 |
---|---|
Provider Name | Jaskamal P Kahlon |
First Address | Mesa, AZ 85206-4394 |
Second Address | Mesa, AZ 85206-1749 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 10/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
74553 | (05) | AZ |
H84033 | (02) | AZ |
P00022765 | RAIL ROAD MEDICARE (01) | AZ |