1790109098 NPI number — HAIDER MICHAEL KALHAN B.D.S

Table of content: NINA FORZA (NPI 1487475653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790109098 NPI number — HAIDER MICHAEL KALHAN B.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KALHAN
Provider First Name:
HAIDER
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
B.D.S
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AL MOHAMADWAY
Provider Other First Name:
HAIDER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1790109098
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3800 BYRON AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98229-2877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-282-0804
Provider Business Mailing Address Fax Number:
360-550-6505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 W 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPPENISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98948-1564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-865-3886
Provider Business Practice Location Address Fax Number:
509-865-6391
Provider Enumeration Date:
02/07/2014

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: 1223D0001X , with the licence number:  RR60356146 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60465251 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1790109098 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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