Healthcare Provider Details

I. General information

NPI: 1487116117
Provider Name (Legal Business Name): KIRANDEEP CHAHAL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 W HORIZON RIDGE PKWY
HENDERSON NV
89052-5075
US

IV. Provider business mailing address

11315 GRAVITATION DR
LAS VEGAS NV
89135-3411
US

V. Phone/Fax

Practice location:
  • Phone: 702-564-8556
  • Fax: 702-564-4485
Mailing address:
  • Phone: 571-527-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO3223
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: