Provider Demographics
NPI:1467639880
Name:KANDKHOROVA, NELLYA (MD)
Entity Type:Individual
Prefix:DR
First Name:NELLYA
Middle Name:
Last Name:KANDKHOROVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NELLYA
Other - Middle Name:
Other - Last Name:SHAMALOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:314 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3730
Mailing Address - Country:US
Mailing Address - Phone:559-791-7000
Mailing Address - Fax:559-782-1418
Practice Address - Street 1:1107 W. POPLAR AVE.
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5839
Practice Address - Country:US
Practice Address - Phone:559-781-7242
Practice Address - Fax:559-782-8259
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-28
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247416207R00000X
CAA107129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine