Provider Demographics
NPI:1396851333
Name:KOTIYAN, DINAKAR
Entity Type:Individual
Prefix:
First Name:DINAKAR
Middle Name:
Last Name:KOTIYAN
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 1:4161 W KLING ST
Mailing Address - Street 2:# 16
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3363
Mailing Address - Country:US
Mailing Address - Phone:818-953-7115
Mailing Address - Fax:818-953-7163
Practice Address - Street 1:4161 W KLING ST
Practice Address - Street 2:,# 16
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-3363
Practice Address - Country:US
Practice Address - Phone:818-953-7115
Practice Address - Fax:818-953-7163
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 14868363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP14868BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER