Healthcare Provider Details

I. General information

NPI: 1922016021
Provider Name (Legal Business Name): RANDHIR KABOO M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 HWY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

101 S 1ST ST 1000
BURBANK CA
91502-1938
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax: 760-242-9167
Mailing address:
  • Phone: 818-845-6206
  • Fax: 818-845-9774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: RANDHIR KABOO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-255-0614