Provider Demographics
NPI:1730468745
Name:KPAB MD INC
Entity Type:Organization
Organization Name:KPAB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATHIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-715-5276
Mailing Address - Street 1:4276 54TH PLACE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2332 REO DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3024
Practice Address - Country:US
Practice Address - Phone:619-267-0553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-08
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty