1053800060 NPI number — MR. MANJINDER SINGH KAHLON M.D.

Table of content: MR. MANJINDER SINGH KAHLON M.D. (NPI 1053800060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053800060 NPI number — MR. MANJINDER SINGH KAHLON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAHLON
Provider First Name:
MANJINDER
Provider Middle Name:
SINGH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053800060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/13/2018
NPI Reactivation Date:
12/31/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 29TH STREET SE
Provider Second Line Business Mailing Address:
APT. 1
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
647-687-0672
Provider Business Mailing Address Fax Number:
304-388-4621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 MACCORKLE AVE SE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF FAMILY MEDICINE
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-388-4600
Provider Business Practice Location Address Fax Number:
304-388-4621
Provider Enumeration Date:
05/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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