Provider Demographics
NPI:1083955686
Name:KVANLI, JOEL (PA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:KVANLI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 W NORTHWEST HWY
Mailing Address - Street 2:STE 3100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4433
Mailing Address - Country:US
Mailing Address - Phone:214-352-3000
Mailing Address - Fax:
Practice Address - Street 1:2351 W NORTHWEST HWY
Practice Address - Street 2:STE 3100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:214-352-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant