Healthcare Provider Details

I. General information

NPI: 1104805670
Provider Name (Legal Business Name): JUGTA KAHAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MEMORIAL DR
JACKSONVILLE NC
28546-6328
US

IV. Provider business mailing address

118 MEMORIAL DR
JACKSONVILLE NC
28546-6328
US

V. Phone/Fax

Practice location:
  • Phone: 910-353-0581
  • Fax: 910-577-1150
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9900076
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: