Provider Demographics
NPI:1255324083
Name:KASHYAP, VIKRAM
Entity Type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:KASHYAP
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 1:4242 MEDICAL DR
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5640
Mailing Address - Country:US
Mailing Address - Phone:210-692-0224
Mailing Address - Fax:210-614-8165
Practice Address - Street 1:17720 CORPORATE WOODS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3500
Practice Address - Country:US
Practice Address - Phone:409-457-4422
Practice Address - Fax:314-887-7501
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM07742084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK0139190OtherDPS
TX173563101Medicaid
TX173563101Medicaid
TX8D5779Medicare PIN
TXK0139190OtherDPS
TXBK9141918OtherDEA
TX173563101Medicaid