Provider Demographics
NPI:1821279423
Name:ANANTH, KARTIK (MD)
Entity Type:Individual
Prefix:DR
First Name:KARTIK
Middle Name:
Last Name:ANANTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23150 CRENSHAW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3025
Mailing Address - Country:US
Mailing Address - Phone:310-437-7999
Mailing Address - Fax:210-437-7398
Practice Address - Street 1:23150 CRENSHAW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3025
Practice Address - Country:US
Practice Address - Phone:310-437-7399
Practice Address - Fax:310-437-7398
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1090162084P0800X, 208VP0014X, 2084P2900X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFK980YMedicare PIN