MEDICARE: DR. AKSHAY KAUSHAL

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	122300000X	Dentist	34280	TX

General Provider Information

NPI Number	:	1952830952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AKSHAY KAUSHAL

Provider Business Mailing Address
First Line	:	200 MLK JR BLVD
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-1152
Country	:	US
Telephone Number	:	940-397-2692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 HULL STREET RD STE A
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23224-1714
Country	:	US
Telephone Number	:	804-233-0007
Fax Number	:

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

Provider Enumeration Date	:	06/05/2017
Last Update Date	:	02/19/2019

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