Provider Demographics
NPI:1427029768
Name:SWAMYNATHAN, KALA (MD)
Entity type:Individual
Prefix:MRS
First Name:KALA
Middle Name:
Last Name:SWAMYNATHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6037
Mailing Address - Country:US
Mailing Address - Phone:209-948-5515
Mailing Address - Fax:209-948-9321
Practice Address - Street 1:1805 N CALIFORNIA ST
Practice Address - Street 2:AUITE 101
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6037
Practice Address - Country:US
Practice Address - Phone:209-948-5515
Practice Address - Fax:209-948-9321
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A638771Medicaid
CA00A638774Medicare PIN
CA00A638773Medicare UPIN
CA00A638772Medicare PIN
CA00A638771Medicaid
CA00A638771Medicare PIN