Provider Demographics
NPI:1083863765
Name:KANAN MANIAR, MD INC
Entity Type:Organization
Organization Name:KANAN MANIAR, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KANAN
Authorized Official - Middle Name:DEEPAK
Authorized Official - Last Name:MANIAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-972-2249
Mailing Address - Street 1:24 WILLIE MAYS PLZ
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-2134
Mailing Address - Country:US
Mailing Address - Phone:415-972-2249
Mailing Address - Fax:415-947-3099
Practice Address - Street 1:24 WILLIE MAYS PLZ
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-2134
Practice Address - Country:US
Practice Address - Phone:415-972-2249
Practice Address - Fax:415-947-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B1797ZMedicare PIN
MDH99511Medicare UPIN
B1795ZMedicare PIN