Provider Demographics
NPI:1013582113
Name:KC, KAILASH (DO)
Entity type:Individual
Prefix:
First Name:KAILASH
Middle Name:
Last Name:KC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:826 MAIN STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-4459
Mailing Address - Country:US
Mailing Address - Phone:832-316-1019
Mailing Address - Fax:
Practice Address - Street 1:826 MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4459
Practice Address - Country:US
Practice Address - Phone:832-316-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-21
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS024010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine