Provider Demographics
NPI:1245255025
Name:KHALSA, JAPA K (DOM)
Entity type:Individual
Prefix:DR
First Name:JAPA
Middle Name:K
Last Name:KHALSA
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CAMINO MIRAMONTES
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-8060
Mailing Address - Country:US
Mailing Address - Phone:505-929-2935
Mailing Address - Fax:505-753-4006
Practice Address - Street 1:228 CAMINO MIRAMONTES
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-8060
Practice Address - Country:US
Practice Address - Phone:505-929-2935
Practice Address - Fax:505-753-4006
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM854171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist