Provider Demographics
NPI:1295758498
Name:PATEL, KANU K (MD)
Entity type:Individual
Prefix:DR
First Name:KANU
Middle Name:K
Last Name:PATEL
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 1:7851 WALKER ST
Mailing Address - Street 2:#103
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623
Mailing Address - Country:US
Mailing Address - Phone:714-739-4211
Mailing Address - Fax:714-739-4219
Practice Address - Street 1:7851 WALKER ST
Practice Address - Street 2:#103
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623
Practice Address - Country:US
Practice Address - Phone:714-739-4211
Practice Address - Fax:714-739-4219
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32124207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321240Medicaid
CA00A321240Medicaid
A32124Medicare ID - Type Unspecified