Provider Demographics
NPI:1215490123
Name:DAHAL, KHEM
Entity type:Individual
Prefix:
First Name:KHEM
Middle Name:
Last Name:DAHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 CEDAR RUN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8808
Mailing Address - Country:US
Mailing Address - Phone:602-545-9031
Mailing Address - Fax:
Practice Address - Street 1:881 CEDAR RUN DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-8808
Practice Address - Country:US
Practice Address - Phone:025-459-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide