MEDICARE: YASHMERI KUILAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246Z00000X	Other Specialist/Technologist		TX

General Provider Information

NPI Number	:	1306687728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASHMERI KUILAN

Provider Business Mailing Address
First Line	:	3507 WEYBURN DR
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76084-1174
Country	:	US
Telephone Number	:	817-487-5098
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 E OAK ST STE 102
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-7713
Country	:	US
Telephone Number	:	817-487-5098
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	06/03/2024

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Directions to “ YASHMERI KUILAN ” Practice Location

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