Provider Demographics
NPI:1225254139
Name:EJAZ KAMBOJ, MD, INC.
Entity Type:Organization
Organization Name:EJAZ KAMBOJ, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EJAZ
Authorized Official - Middle Name:U
Authorized Official - Last Name:KAMBOJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-650-0009
Mailing Address - Street 1:1770 N BUFFALO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2679
Mailing Address - Country:US
Mailing Address - Phone:702-650-0009
Mailing Address - Fax:702-233-5764
Practice Address - Street 1:1770 N BUFFALO DR STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-2679
Practice Address - Country:US
Practice Address - Phone:702-650-0009
Practice Address - Fax:702-233-5764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018267Medicaid
NVV38251Medicare PIN
NVG67436Medicare UPIN