Healthcare Provider Details

I. General information

NPI: 1043510183
Provider Name (Legal Business Name): KANSAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date: 09/09/2021
Reactivation Date: 09/14/2021

III. Provider practice location address

8733 BEVERLY BLVD STE 306
WEST HOLLYWOOD CA
90048-1843
US

IV. Provider business mailing address

5410 MARYLAND WAY STE 300
BRENTWOOD TN
37027-5339
US

V. Phone/Fax

Practice location:
  • Phone: 310-388-6798
  • Fax: 323-400-4302
Mailing address:
  • Phone: 615-377-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA FALL
Title or Position: MANAGER
Credential:
Phone: 253-682-6040