Provider Demographics
NPI:1841384468
Name:KANAKESWARAN, KANAGASABAI (MD)
Entity Type:Individual
Prefix:DR
First Name:KANAGASABAI
Middle Name:
Last Name:KANAKESWARAN
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 1:1601 W AVENUE J
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2824
Mailing Address - Country:US
Mailing Address - Phone:661-942-9072
Mailing Address - Fax:
Practice Address - Street 1:1601 W AVENUE J
Practice Address - Street 2:SUITE 202
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2824
Practice Address - Country:US
Practice Address - Phone:661-942-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A631591Medicaid
CAW15951Medicare PIN
CA00A631591Medicaid