Provider Demographics
NPI:1831436534
Name:CHAHAL, KAVALJIT K (NP)
Entity type:Individual
Prefix:MRS
First Name:KAVALJIT
Middle Name:K
Last Name:CHAHAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24302 PASEO DE VALENCIA
Mailing Address - Street 2:STE 200
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3115
Mailing Address - Country:US
Mailing Address - Phone:562-477-2750
Mailing Address - Fax:
Practice Address - Street 1:24302 PASEO DE VALENCIA
Practice Address - Street 2:SUITE 200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3115
Practice Address - Country:US
Practice Address - Phone:949-458-8252
Practice Address - Fax:949-588-8252
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP22415363L00000X
CA22415302R00000X, 363LA2200X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health