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General NPI Number Information
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NPI Number | 1164448338
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Entity Type | Individual
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Provider Name | GAGAN KHALSA MD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 12/04/2022
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Provider Practice Location Address
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Address Line | 800 5TH AVE STE 600
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City | SEATTLE
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State | WA
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Zip | 98104-3186
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Country | US
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Telephone | 425-828-3626
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Fax |
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Provider Business Mailing Address
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Address Line | 800 5TH AVE STE 600
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City | SEATTLE
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State | WA
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Zip | 98104-3186
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Country | US
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Telephone |
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036-113280
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD60037718
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License Number State | WA
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