Provider Demographics
NPI:1023155934
Name:KABOO, RANDHIR (MD)
Entity type:Individual
Prefix:
First Name:RANDHIR
Middle Name:
Last Name:KABOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19220 CATALINA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-6798
Mailing Address - Country:US
Mailing Address - Phone:760-508-2417
Mailing Address - Fax:
Practice Address - Street 1:18300 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2206
Practice Address - Country:US
Practice Address - Phone:760-242-2311
Practice Address - Fax:760-242-9167
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83963207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H95022Medicare UPIN
CA00A839630Medicare ID - Type Unspecified
CAAS050YMedicare PIN