Provider Demographics
NPI:1033150933
Name:KEESARA, VINAY VR (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:VR
Last Name:KEESARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9375 SAN FERNANDO ROAD
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91352
Mailing Address - Country:US
Mailing Address - Phone:818-504-4700
Mailing Address - Fax:818-504-4690
Practice Address - Street 1:9375 SAN FERNANDO RD
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91352-1418
Practice Address - Country:US
Practice Address - Phone:818-768-3000
Practice Address - Fax:818-504-4690
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44003207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440030Medicaid
CAD15951Medicare UPIN
CA00A440030Medicaid