Provider Demographics
NPI:1811194343
Name:GANESAN, KALPANA
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:
Last Name:GANESAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SAN PASQUAL ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3549
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7601 IMPERIAL HWAY
Practice Address - Street 2:RANCHO LOS MIGOS NATIONAL REHABILITATION CENTER
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:562-401-7611
Practice Address - Fax:562-401-7615
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48796207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF69105Medicare UPIN