Healthcare Provider Details

I. General information

NPI: 1710341698
Provider Name (Legal Business Name): KAITLIN GEORGEANNE JANNING BOKHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 GASTON AVE
DALLAS TX
75246-2017
US

IV. Provider business mailing address

7151 GASTON AVE APT 416
DALLAS TX
75214-4150
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-2361
  • Fax:
Mailing address:
  • Phone: 214-208-0619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberT0429
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: