Provider Demographics
NPI:1245289420
Name:VENKATESAN, KALPATHY V (MD)
Entity type:Individual
Prefix:
First Name:KALPATHY
Middle Name:V
Last Name:VENKATESAN
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 1:365 PEARSON DR
Mailing Address - Street 2:SUITE #5
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3360
Mailing Address - Country:US
Mailing Address - Phone:559-788-2175
Mailing Address - Fax:559-788-2227
Practice Address - Street 1:365 PEARSON DR
Practice Address - Street 2:SUITE #5
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3360
Practice Address - Country:US
Practice Address - Phone:559-788-2175
Practice Address - Fax:559-788-2227
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2048207RH0003X
CAA38108207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB80961Medicare UPIN