Provider Demographics
NPI:1730465931
Name:KANNAN, RAMESH (LAC)
Entity Type:Individual
Prefix:MR
First Name:RAMESH
Middle Name:
Last Name:KANNAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 SOQUEL AVE # 75
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2305
Mailing Address - Country:US
Mailing Address - Phone:831-331-5800
Mailing Address - Fax:
Practice Address - Street 1:2 CAMERON WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94124-3702
Practice Address - Country:US
Practice Address - Phone:415-822-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-01
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist