Provider Demographics
NPI:1073533212
Name:MAGANTI, KALYANI (MD)
Entity Type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:
Last Name:MAGANTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-627-3424
Mailing Address - Fax:925-627-3560
Practice Address - Street 1:3903 LONE TREE WAY
Practice Address - Street 2:SUITE 205
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6249
Practice Address - Country:US
Practice Address - Phone:925-754-8710
Practice Address - Fax:925-754-0765
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80972207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A809720Medicaid
00A809722Medicare PIN
CA00A809720Medicaid