Provider Demographics
NPI:1609810357
Name:BHATIA, KAVITHA REDDY (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:REDDY
Last Name:BHATIA
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 1:1811 WILSHIRE BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5626
Mailing Address - Country:US
Mailing Address - Phone:310-453-9010
Mailing Address - Fax:310-828-3661
Practice Address - Street 1:201 AVONDALE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3601
Practice Address - Country:US
Practice Address - Phone:310-210-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11810Medicare ID - Type UnspecifiedGROUP NUMBER