Provider Demographics
NPI:1578662490
Name:HANSUVADHA, KASEMSANT (MD)
Entity Type:Individual
Prefix:
First Name:KASEMSANT
Middle Name:
Last Name:HANSUVADHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:K
Other - Last Name:HANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2204 INDIAN WELLS CT.
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6755
Mailing Address - Country:US
Mailing Address - Phone:805-983-6197
Mailing Address - Fax:
Practice Address - Street 1:963 W 7TH ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6755
Practice Address - Country:US
Practice Address - Phone:805-487-9897
Practice Address - Fax:805-487-6667
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38775208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A387750Medicaid
CA00A387750Medicaid