Provider Demographics
NPI:1942501317
Name:KANU K PATEL M D INC
Entity Type:Organization
Organization Name:KANU K PATEL M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KANUBHAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-739-4211
Mailing Address - Street 1:7851 WALKER ST #103
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1734
Mailing Address - Country:US
Mailing Address - Phone:714-739-4211
Mailing Address - Fax:714-739-4219
Practice Address - Street 1:7851 WALKER ST #103
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1734
Practice Address - Country:US
Practice Address - Phone:714-739-4211
Practice Address - Fax:714-739-4219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-32124207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA-32124Medicaid
CAB50187Medicare UPIN