Healthcare Provider Details

I. General information

NPI: 1144278805
Provider Name (Legal Business Name): NIKHIL KANSAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MC 8201
SAN DIEGO CA
92103-8201
US

IV. Provider business mailing address

200 W ARBOR DR MC 8403
SAN DIEGO CA
92103-8403
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1899
  • Fax: 619-543-3183
Mailing address:
  • Phone: 619-543-6980
  • Fax: 619-543-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA73784
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA73784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: