Provider Demographics
NPI:1043510183
Name:KANSAL INC
Entity type:Organization
Organization Name:KANSAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:FALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-682-6040
Mailing Address - Street 1:5410 MARYLAND WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5339
Mailing Address - Country:US
Mailing Address - Phone:615-377-1674
Mailing Address - Fax:
Practice Address - Street 1:8733 BEVERLY BLVD STE 306
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1843
Practice Address - Country:US
Practice Address - Phone:310-388-6798
Practice Address - Fax:323-400-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2025-03-07
Deactivation Date:2021-09-09
Deactivation Code:
Reactivation Date:2021-09-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB212049Medicare PIN