Provider Demographics
NPI:1790134666
Name:FATHALLAH, JIHAN (MD)
Entity Type:Individual
Prefix:
First Name:JIHAN
Middle Name:
Last Name:FATHALLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 2027
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-945-3974
Mailing Address - Fax:913-588-0593
Practice Address - Street 1:3901 RAINBOW BLVD.
Practice Address - Street 2:MS 2027
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-945-3974
Practice Address - Fax:913-588-0593
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2017-04-03
Deactivation Date:2017-01-25
Deactivation Code:
Reactivation Date:2017-02-15
Provider Licenses
StateLicense IDTaxonomies
KS94-08951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine