Provider Demographics
NPI:1205018777
Name:KHALSA, SEVA SIMRAN SIRI SINGH (DOM)
Entity Type:Individual
Prefix:DR
First Name:SEVA SIMRAN
Middle Name:SIRI SINGH
Last Name:KHALSA
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 SAN ILDEFONSO ST
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-3213
Mailing Address - Country:US
Mailing Address - Phone:505-747-7944
Mailing Address - Fax:505-747-7944
Practice Address - Street 1:1026 SAN ILDEFONSO ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3213
Practice Address - Country:US
Practice Address - Phone:505-747-7944
Practice Address - Fax:505-747-7944
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist