Provider Demographics
NPI:1609444371
Name:KASHGARIAN, ILHAM MAMAT (MD)
Entity Type:Individual
Prefix:
First Name:ILHAM
Middle Name:MAMAT
Last Name:KASHGARIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YILAMUJIANG
Other - Middle Name:
Other - Last Name:MAIMAITI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:ROBERT C. BIRD CLINICAL TRAINING CENTER , 4TH FLOOR
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1297
Mailing Address - Country:US
Mailing Address - Phone:304-388-5590
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:3200 MACCORKLE AVE SE
Practice Address - Street 2:ROBERT C. BIRD CLINICAL TRAINING CENTER , 4TH FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1297
Practice Address - Country:US
Practice Address - Phone:304-388-5590
Practice Address - Fax:304-388-8238
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program