Provider Demographics
NPI:1982640892
Name:KANNAN CLINIC, P.C.
Entity Type:Organization
Organization Name:KANNAN CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HARI
Authorized Official - Middle Name:DASAN
Authorized Official - Last Name:KANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-728-1902
Mailing Address - Street 1:5120 S WESTERN AVE
Mailing Address - Street 2:STE. 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5013
Mailing Address - Country:US
Mailing Address - Phone:605-271-3900
Mailing Address - Fax:605-271-3902
Practice Address - Street 1:5120 S WESTERN AVE
Practice Address - Street 2:STE. 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5013
Practice Address - Country:US
Practice Address - Phone:605-271-3900
Practice Address - Fax:605-271-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD34862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDF00653Medicare UPIN