Provider Demographics
NPI:1255319992
Name:PERUMAL, KANDASAMY CHETTY (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:KANDASAMY
Middle Name:CHETTY
Last Name:PERUMAL
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:135 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2558
Practice Address - Country:US
Practice Address - Phone:864-882-8074
Practice Address - Fax:864-882-1908
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148557-1208800000X
SC86822208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCL859Medicaid
NYBB1649Medicare PIN