Provider Demographics
NPI:1568950855
Name:KALEN, CHEMANTHI ROCHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHEMANTHI
Middle Name:ROCHELLE
Last Name:KALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHEMANTHI
Other - Middle Name:ROCHELLE
Other - Last Name:EDIRIWEERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2435 FIRE MESA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-9009
Mailing Address - Country:US
Mailing Address - Phone:725-200-3232
Mailing Address - Fax:
Practice Address - Street 1:2435 FIRE MESA ST STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9009
Practice Address - Country:US
Practice Address - Phone:725-200-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty