Provider Demographics
NPI:1033006713
Name:KAHLON, GULBAG SINGH (PHYSICIAN ASSOCIATE)
Entity type:Individual
Prefix:
First Name:GULBAG
Middle Name:SINGH
Last Name:KAHLON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 VENTANA DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5616
Mailing Address - Country:US
Mailing Address - Phone:909-275-1744
Mailing Address - Fax:
Practice Address - Street 1:5890 VENTANA DR
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-5616
Practice Address - Country:US
Practice Address - Phone:909-275-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty