Provider Demographics
NPI:1891966412
Name:KANNARKAT, VINOD TONY (MD)
Entity Type:Individual
Prefix:
First Name:VINOD
Middle Name:TONY
Last Name:KANNARKAT
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 1:520 SUPERIOR AVE STE 255
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3668
Mailing Address - Country:US
Mailing Address - Phone:949-642-5513
Mailing Address - Fax:949-642-9479
Practice Address - Street 1:4695 MACARTHUR CT # 1112A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1882
Practice Address - Country:US
Practice Address - Phone:949-642-5513
Practice Address - Fax:949-642-9479
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 103084207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCB214160Medicare PIN