Provider Demographics
NPI:1558924613
Name:SANJAY KANDOTH MD PC
Entity Type:Organization
Organization Name:SANJAY KANDOTH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KANDOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-254-5437
Mailing Address - Street 1:3061 S MARYLAND PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-6226
Mailing Address - Country:US
Mailing Address - Phone:702-254-5437
Mailing Address - Fax:
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 10A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5991
Practice Address - Country:US
Practice Address - Phone:702-254-5437
Practice Address - Fax:702-254-7354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty