Healthcare Provider Details

I. General information

NPI: 1689671034
Provider Name (Legal Business Name): KISHORE SEHGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N SAN JACINTO ST
HEMET CA
92543-3113
US

IV. Provider business mailing address

40229 DONOMORE CT
TEMECULA CA
92591-1611
US

V. Phone/Fax

Practice location:
  • Phone: 951-766-6460
  • Fax: 951-766-6459
Mailing address:
  • Phone: 951-695-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA42484
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA42484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: