Provider Demographics
NPI:1326136540
Name:KAHLOON, NINA (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:KAHLOON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950266
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0266
Mailing Address - Country:US
Mailing Address - Phone:502-896-6355
Mailing Address - Fax:502-896-9813
Practice Address - Street 1:2811 KLEMPNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-896-6355
Practice Address - Fax:502-708-4022
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32396207NP0225X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64323967-00Medicaid
KY2436691000OtherPASSPORT ADVANTAGE
KY1110680OtherPASSPORT
KY1079603Medicare ID - Type Unspecified
KYG99681Medicare UPIN
KY1110680OtherPASSPORT