Basic Information
| Provider Information | |||||||||
| NPI: | 1093783953 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KAHLON | ||||||||
| FirstName: | JASKAMAL | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6402 E SUPERSTITION SPRINGS BLVD STE 224 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808356100 | ||||||||
| FaxNumber: | 4804614261 | ||||||||
| Practice Location | |||||||||
| Address1: | 6750 E BAYWOOD AVE | ||||||||
| Address2: | 301 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852061749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808356100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 06/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 31362 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 31362 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | P00022765 | 01 | AZ | RAIL ROAD MEDICARE | OTHER | 74553 | 05 | AZ | MEDICAID |