Provider Demographics
NPI:1891334652
Name:KAHLON, RAJDEEP KAUR
Entity Type:Individual
Prefix:
First Name:RAJDEEP
Middle Name:KAUR
Last Name:KAHLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5545 MARCONI AVE APT 211
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-4449
Mailing Address - Country:US
Mailing Address - Phone:510-552-4866
Mailing Address - Fax:
Practice Address - Street 1:6420 RIO LINDA BLVD
Practice Address - Street 2:
Practice Address - City:RIO LINDA
Practice Address - State:CA
Practice Address - Zip Code:95673-3332
Practice Address - Country:US
Practice Address - Phone:916-992-5403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81520183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist