Healthcare Provider Details

I. General information

NPI: 1073431094
Provider Name (Legal Business Name): NITHYA JEEVAHANSI KAHANDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S FAIRFIELD AVE
CHICAGO IL
60608-1782
US

IV. Provider business mailing address

1810 SCENIC VIEW CIR
WEST COVINA CA
91791-4020
US

V. Phone/Fax

Practice location:
  • Phone: 773-542-2000
  • Fax:
Mailing address:
  • Phone: 626-806-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041550920
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: