Provider Demographics
NPI:1215220124
Name:KISHAN CHAND MDPA
Entity Type:Organization
Organization Name:KISHAN CHAND MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-572-5180
Mailing Address - Street 1:2700 CITIZENS PLAZA
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901
Mailing Address - Country:US
Mailing Address - Phone:361-572-5180
Mailing Address - Fax:361-572-5152
Practice Address - Street 1:2700 CITIZENS PLAZA
Practice Address - Street 2:SUITE 301
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-572-5180
Practice Address - Fax:361-572-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty