Basic Information
| Provider Information | |||||||||
| NPI: | 1699726240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KALLA | ||||||||
| FirstName: | SUNIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 E SILVERADO RANCH BLVD | ||||||||
| Address2: | SUITE #170 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891837516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022406482 | ||||||||
| FaxNumber: | 7022408529 | ||||||||
| Practice Location | |||||||||
| Address1: | 2779 W HORIZON RIDGE PKWY | ||||||||
| Address2: | SUITE #240 | ||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890524184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022406482 | ||||||||
| FaxNumber: | 7022408529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 01/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 9939 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | V103055 | 01 | NV | MEDICARE GROUP PTAN | OTHER | 20-0562668 | 01 | NV | TAX ID# | OTHER | V102532 | 01 | RETIRED RAILROAD MEDICARE PIN | OTHER |