Healthcare Provider Details

I. General information

NPI: 1487676243
Provider Name (Legal Business Name): SANJAY KAMBOJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST ESPLANADE AVE, STE 205 LSUHN MULTISPECIALTY CLINIC/S. KABBOJ
KENNER LA
70065
US

IV. Provider business mailing address

1542 TULANE AVE, BOX T4M-2 LSUHSC- S. KAMBOJ
NEW ORLEANS LA
70112
US

V. Phone/Fax

Practice location:
  • Phone: 504-412-1705
  • Fax: 504-412-1726
Mailing address:
  • Phone: 504-568-5722
  • Fax: 504-567-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD026647
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD026647
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number26647
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD026647
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: