Provider Demographics
NPI:1396833810
Name:KAMBOJ, EJAZ U (MD)
Entity Type:Individual
Prefix:
First Name:EJAZ
Middle Name:U
Last Name:KAMBOJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 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:702-233-5786
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:702-233-5786
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018267Medicaid
NV002018267Medicaid
NVV38252Medicare PIN