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General NPI Number Information
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NPI Number | 1114334273
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Entity Type | Individual
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Provider Name | JESSICA KIM-VAGHELA D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 3010 WESTCHESTER AVE STE 400
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City | PURCHASE
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State | NY
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Zip | 10577
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Country | US
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Telephone | 914-235-6060
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Fax | 914-235-1215
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Provider Business Mailing Address
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Address Line | 3010 WESTCHESTER AVE STE 400
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City | PURCHASE
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State | NY
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Zip | 10577-2524
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Country | US
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Telephone | 914-235-6060
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Fax | 914-235-1215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 60083
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License Number State | CT
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