Provider Demographics
NPI:1053800060
Name:KAHLON, MANJINDER SINGH (MD)
Entity type:Individual
Prefix:MR
First Name:MANJINDER
Middle Name:SINGH
Last Name:KAHLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 29TH STREET SE
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:647-687-0672
Mailing Address - Fax:304-388-4621
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-4600
Practice Address - Fax:304-388-4621
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-12-31
Deactivation Date:2018-12-13
Deactivation Code:
Reactivation Date:2018-12-31
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program