Provider Demographics
NPI:1568420693
Name:KALLA, YAMINI (MD)
Entity Type:Individual
Prefix:
First Name:YAMINI
Middle Name:
Last Name:KALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 PINE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2450
Mailing Address - Country:US
Mailing Address - Phone:325-670-5570
Mailing Address - Fax:325-670-4017
Practice Address - Street 1:1904 PINE ST
Practice Address - Street 2:STE 200
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2450
Practice Address - Country:US
Practice Address - Phone:325-670-5570
Practice Address - Fax:325-670-4017
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8093207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165048301Medicaid
H56447Medicare UPIN
TX165048301Medicaid