1144332487 NPI number — TEHMINA KANWAL MD

Table of content: TEHMINA KANWAL MD (NPI 1144332487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144332487 NPI number — TEHMINA KANWAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANWAL
Provider First Name:
TEHMINA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1144332487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9140 ALCOSTA BLVD
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
SAN RAMON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94583-3858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-361-5959
Provider Business Mailing Address Fax Number:
925-361-0375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9140 ALCOSTA BLVD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-3858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-361-5959
Provider Business Practice Location Address Fax Number:
925-361-0375
Provider Enumeration Date:
08/31/2006

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: 207R00000X , with the licence number:  A90031 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: D0057389 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 685602100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KDKITE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 88648 . This is a "AMERIGROUP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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