Provider Demographics
NPI:1043501174
Name:PANACH, KAMALDEEP (MD)
Entity Type:Individual
Prefix:
First Name:KAMALDEEP
Middle Name:
Last Name:PANACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:PANACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:29826 HAUN RD STE 302
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92586-6547
Mailing Address - Country:US
Mailing Address - Phone:951-672-1911
Mailing Address - Fax:
Practice Address - Street 1:29826 HAUN RD STE 302
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92586-6547
Practice Address - Country:US
Practice Address - Phone:951-672-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-23
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA131368208M00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043501174OtherNPI
TX1376541193OtherGROUP NPI
TX1376541193OtherGROUP NPI