Provider Demographics
NPI:1952045536
Name:AVANA HEALTH LLC
Entity Type:Organization
Organization Name:AVANA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ASHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-661-5525
Mailing Address - Street 1:PO BOX 510083
Mailing Address - Street 2:
Mailing Address - City:KEALIA
Mailing Address - State:HI
Mailing Address - Zip Code:96751-0083
Mailing Address - Country:US
Mailing Address - Phone:808-431-5322
Mailing Address - Fax:808-427-6093
Practice Address - Street 1:5409 LAIPO RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2118
Practice Address - Country:US
Practice Address - Phone:808-431-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-21
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty