Provider Demographics
NPI:1164510012
Name:BERERA, KAILASH (MD)
Entity Type:Individual
Prefix:MRS
First Name:KAILASH
Middle Name:
Last Name:BERERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 E CHAPMAN AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5086
Mailing Address - Country:US
Mailing Address - Phone:714-577-5400
Mailing Address - Fax:
Practice Address - Street 1:377 E CHAPMAN AVE STE 110
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5086
Practice Address - Country:US
Practice Address - Phone:714-577-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA343622084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry