Provider Demographics
NPI:1578578365
Name:SIVALINGAM, KANAGARATNAM (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAGARATNAM
Middle Name:
Last Name:SIVALINGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44725 N. 10TH ST WEST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534
Mailing Address - Country:US
Mailing Address - Phone:661-726-3724
Mailing Address - Fax:661-726-3723
Practice Address - Street 1:44725 N. 10TH ST. WEST
Practice Address - Street 2:SUITE 170
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-726-3724
Practice Address - Fax:661-726-3063
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30091207RG0300X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25962Medicare UPIN