Provider Demographics
NPI:1649307356
Name:TRIVEDI, KASHYAP HARSHAD (MD)
Entity type:Individual
Prefix:MR
First Name:KASHYAP
Middle Name:HARSHAD
Last Name:TRIVEDI
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 1:4772 KATELLA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2683
Mailing Address - Country:US
Mailing Address - Phone:562-596-5552
Mailing Address - Fax:562-596-5340
Practice Address - Street 1:4772 KATELLA AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2683
Practice Address - Country:US
Practice Address - Phone:562-596-5552
Practice Address - Fax:562-596-5340
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90430207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology