Basic Information
| Provider Information | |||||||||
| NPI: | 1619238748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUR | ||||||||
| FirstName: | GIRISHA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 15645 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891145645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027371880 | ||||||||
| FaxNumber: | 7026502458 | ||||||||
| Practice Location | |||||||||
| Address1: | 4475 S EASTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891197826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027371880 | ||||||||
| FaxNumber: | 7026502458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2012 | ||||||||
| LastUpdateDate: | 01/17/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | KY | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 16042 | NV | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1619238748 | 01 | NV | SMA MEDICAID | OTHER | 7100262410 | 05 | KY | MEDICAID | V111262 | 01 | NV | SMA MEDICARE | OTHER |