MEDICARE: KANWALJIT SINGH KAHLON M.D.

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	174400000X	Specialist	0090-00837	NC
2	207R00000X	Internal Medicine Physician	C54684	CA
3	208M00000X	Hospitalist Physician	C54684	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C54684	OTHER	CA	MEDICAL STATE LICENSE

General Provider Information

NPI Number	:	1700980315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANWALJIT SINGH KAHLON M.D.

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 PRAIRIE CITY RD
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-9594
Country	:	US
Telephone Number	:	916-351-4800
Fax Number	:	916-351-4899

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	03/16/2020

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