Provider Demographics
NPI:1144278805
Name:KANSAL, NIKHIL (MD)
Entity type:Individual
Prefix:DR
First Name:NIKHIL
Middle Name:
Last Name:KANSAL
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 1:200 W ARBOR DR
Mailing Address - Street 2:MC 8403
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8403
Mailing Address - Country:US
Mailing Address - Phone:619-543-6980
Mailing Address - Fax:619-543-2615
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 8201
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8201
Practice Address - Country:US
Practice Address - Phone:619-543-1899
Practice Address - Fax:619-543-3183
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73784208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A737840Medicaid
H64797Medicare UPIN
CAWA73784AMedicare ID - Type Unspecified