Provider Demographics
NPI:1518455120
Name:KANTHASAMY, KAVIN
Entity type:Individual
Prefix:
First Name:KAVIN
Middle Name:
Last Name:KANTHASAMY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN STREET
Mailing Address - Street 2:SMITH TOWER, SUITE 1201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:515-520-0028
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN STREET
Practice Address - Street 2:SMITH TOWER, SUITE 1201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-441-3372
Practice Address - Fax:713-797-0622
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU6737207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology