Provider Demographics
NPI:1568482461
Name:DUA, KIRAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:P
Last Name:DUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8349 RESEDA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5914
Mailing Address - Country:US
Mailing Address - Phone:818-886-7322
Mailing Address - Fax:
Practice Address - Street 1:8349 RESEDA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5914
Practice Address - Country:US
Practice Address - Phone:818-886-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35425208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50288Medicare UPIN