Healthcare Provider Details

I. General information

NPI: 1699726240
Provider Name (Legal Business Name): SUNIL KALLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2779 W HORIZON RIDGE PKWY SUITE #240
HENDERSON NV
89052-4184
US

IV. Provider business mailing address

700 E SILVERADO RANCH BLVD SUITE #170
LAS VEGAS NV
89183-7516
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-6482
  • Fax: 702-240-8529
Mailing address:
  • Phone: 702-240-6482
  • Fax: 702-240-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9939
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: