Provider Demographics
NPI:1740363878
Name:KANKAR, ANITHA REDDY (MD)
Entity type:Individual
Prefix:DR
First Name:ANITHA
Middle Name:REDDY
Last Name:KANKAR
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 1:8040 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6010
Mailing Address - Country:US
Mailing Address - Phone:818-373-4870
Mailing Address - Fax:818-997-9442
Practice Address - Street 1:8040 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6010
Practice Address - Country:US
Practice Address - Phone:818-373-4870
Practice Address - Fax:818-997-9442
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56356208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563560Medicaid
CA00A563560Medicaid