Provider Demographics
NPI:1184656613
Name:AYYANAR, KANYALAKSHMI (MD)
Entity Type:Individual
Prefix:
First Name:KANYALAKSHMI
Middle Name:
Last Name:AYYANAR
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:ONE BREAKTHROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:702-732-1493
Mailing Address - Fax:702-732-1080
Practice Address - Street 1:ONE BREAKTHROUGH WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135
Practice Address - Country:US
Practice Address - Phone:702-732-1493
Practice Address - Fax:702-732-1080
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY409722080P0207X
NV158652080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200867270Medicaid
KY7100005410Medicaid
KY0053414Medicare PIN