Provider Demographics
NPI:1104805670
Name:KAHAI, JUGTA (MD)
Entity type:Individual
Prefix:
First Name:JUGTA
Middle Name:
Last Name:KAHAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6328
Practice Address - Country:US
Practice Address - Phone:910-353-0581
Practice Address - Fax:910-577-1150
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104805670Medicaid
94057OtherMEDCOST
SCNC2643Medicaid
1228827OtherUNITED HEALTHCARE
NC11997OtherBLUE CROSS BLUE SHIELD
21047OtherCIGNA
BK6289335OtherDEA
NC8911997Medicaid
34D0968311OtherCLIA
030426349OtherTRICARE
030426349OtherTRICARE
NC8911997Medicaid
SCNC2643Medicaid