Provider Demographics
NPI:1295754372
Name:KANDOLA, JASWINDER S (MD)
Entity type:Individual
Prefix:DR
First Name:JASWINDER
Middle Name:S
Last Name:KANDOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4300 HOSPITAL ST
Mailing Address - Street 2:SUITE103
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5329
Mailing Address - Country:US
Mailing Address - Phone:228-762-7875
Mailing Address - Fax:228-762-7876
Practice Address - Street 1:4300 HOSPITAL ST
Practice Address - Street 2:SUITE103
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5329
Practice Address - Country:US
Practice Address - Phone:228-762-7875
Practice Address - Fax:228-762-7876
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS12723207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014934Medicaid
MSE72146Medicare UPIN
MS00014934Medicaid