Provider Demographics
NPI:1245432038
Name:KANESAN, KRISHNAKUMARI (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNAKUMARI
Middle Name:
Last Name:KANESAN
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 1:5502 1ST ST
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2472
Mailing Address - Country:US
Mailing Address - Phone:713-465-6262
Mailing Address - Fax:
Practice Address - Street 1:5502 1ST ST
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2472
Practice Address - Country:US
Practice Address - Phone:713-465-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1060011Medicaid