Provider Demographics
NPI:1629477864
Name:KHALSA, KYAH (ADJ)
Entity Type:Individual
Prefix:
First Name:KYAH
Middle Name:
Last Name:KHALSA
Suffix:
Gender:F
Credentials:ADJ
Other - Prefix:
Other - First Name:KYAH
Other - Middle Name:
Other - Last Name:HOLLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADJ
Mailing Address - Street 1:1211 EMBARCADERO
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-5119
Mailing Address - Country:US
Mailing Address - Phone:510-535-1409
Mailing Address - Fax:510-535-1414
Practice Address - Street 1:1211 EMBARCADERO
Practice Address - Street 2:SUITE 300
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5119
Practice Address - Country:US
Practice Address - Phone:510-535-1409
Practice Address - Fax:510-535-1414
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-13
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health