Provider Demographics
NPI:1649313206
Name:KASHYAP, ANIL K (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:ANIL
Middle Name:K
Last Name:KASHYAP
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 STANTON L YOUNG BLVD DEPT OF
Mailing Address - Street 2:WP-2140
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5036
Mailing Address - Country:US
Mailing Address - Phone:405-271-3677
Mailing Address - Fax:
Practice Address - Street 1:920 STANTON L YOUNG BLVD DEPT
Practice Address - Street 2:WP-2140
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5036
Practice Address - Country:US
Practice Address - Phone:405-271-3677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK31956208200000X
MD160071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery