Provider Demographics
NPI:1881686707
Name:KYLASA, KRISHNA R (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:R
Last Name:KYLASA
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:PO BOX 2447
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93303-2447
Mailing Address - Country:US
Mailing Address - Phone:661-633-5000
Mailing Address - Fax:661-633-2500
Practice Address - Street 1:9602 STOCKDALE HWY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3618
Practice Address - Country:US
Practice Address - Phone:661-633-5000
Practice Address - Fax:661-633-2500
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA889572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A889570Medicaid
CA00A889570Medicaid
CA00A889570Medicare ID - Type Unspecified