Provider Demographics
NPI:1225563026
Name:GANESH, KEVIN NARESH
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:NARESH
Last Name:GANESH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17290 JASMINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-8300
Mailing Address - Country:US
Mailing Address - Phone:760-951-2400
Mailing Address - Fax:760-951-3301
Practice Address - Street 1:17290 JASMINE ST STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-8300
Practice Address - Country:US
Practice Address - Phone:760-951-2400
Practice Address - Fax:760-951-3301
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169955207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease