Provider Demographics
NPI:1790719623
Name:KAHLON, SURJIT KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:SURJIT
Middle Name:KAUR
Last Name:KAHLON
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 1:630 N 13TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4975
Mailing Address - Country:US
Mailing Address - Phone:909-982-2719
Mailing Address - Fax:909-946-9931
Practice Address - Street 1:630 N 13TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4975
Practice Address - Country:US
Practice Address - Phone:909-982-2719
Practice Address - Fax:909-946-9931
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A314221Medicaid
CAA26472Medicare UPIN
CABE245Medicare PIN
CAA31422Medicare ID - Type Unspecified