Provider Demographics
NPI:1245677541
Name:KHALSA, SEVA SIMRAN SINGH (LAC)
Entity type:Individual
Prefix:MR
First Name:SEVA SIMRAN
Middle Name:SINGH
Last Name:KHALSA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2921
Mailing Address - Country:US
Mailing Address - Phone:415-375-0813
Mailing Address - Fax:
Practice Address - Street 1:1390 WALLER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2921
Practice Address - Country:US
Practice Address - Phone:415-375-0813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-2899872OtherEIN