=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689671034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KISHORE SEHGAL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2005
-----------------------------------------------------
Last Update Date | 10/03/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 N SAN JACINTO ST
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92543-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-766-6460
-----------------------------------------------------
Fax | 951-766-6459
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40229 DONOMORE CT
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92591-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-695-2648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A42484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number | A42484
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------