Provider Demographics
NPI:1427421635
Name:KHANSHALI, WALLEAD
Entity type:Individual
Prefix:
First Name:WALLEAD
Middle Name:
Last Name:KHANSHALI
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:PO BOX 640143
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94164-0143
Mailing Address - Country:US
Mailing Address - Phone:510-628-9065
Mailing Address - Fax:
Practice Address - Street 1:1440 BROADWAY STE 610
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2026
Practice Address - Country:US
Practice Address - Phone:510-628-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program