1649945346 NPI number — MS. DIKSHA KAUL

Table of content: MS. DIKSHA KAUL (NPI 1649945346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649945346 NPI number — MS. DIKSHA KAUL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUL
Provider First Name:
DIKSHA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1649945346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/19/2022
NPI Reactivation Date:
09/12/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
APT 524, THE POINT AT 180
Provider Second Line Business Mailing Address:
180 EASTERN AVENUE
Provider Business Mailing Address City Name:
MALDEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11600 S KEDZIE AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRIONETTE PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60803-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-684-6867
Provider Business Practice Location Address Fax Number:
708-684-6869
Provider Enumeration Date:
08/13/2021

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: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 036.170390 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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