=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174256424
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WAHAB KAHLOAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/05/2022
-----------------------------------------------------
Last Update Date | 07/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 TREMONT ST
-----------------------------------------------------
City | N TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-6135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-220-8002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6739 TATTINGER AVENUE
-----------------------------------------------------
City | MISSISSAUGA (MEADOWVALE VILLAGE / WEST G
-----------------------------------------------------
State | ON
-----------------------------------------------------
Zip | L5W1P1
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 338478
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------