Provider Demographics
NPI:1225317068
Name:CHIDAMBARAM, KAVITHA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:CHIDAMBARAM
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 1:20875 VALLEY GREEN DR
Mailing Address - Street 2:17
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-1758
Mailing Address - Country:US
Mailing Address - Phone:608-320-9523
Mailing Address - Fax:
Practice Address - Street 1:1333 MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5212
Practice Address - Country:US
Practice Address - Phone:408-445-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
CA132229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No282N00000XHospitalsGeneral Acute Care Hospital