Provider Demographics
NPI:1780908509
Name:KALPATHY V. VENKATESAN, M.D., INC.
Entity type:Organization
Organization Name:KALPATHY V. VENKATESAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALPATHY
Authorized Official - Middle Name:V
Authorized Official - Last Name:VENKATESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-788-2175
Mailing Address - Street 1:365 PEARSON DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3360
Mailing Address - Country:US
Mailing Address - Phone:559-788-2175
Mailing Address - Fax:559-788-2227
Practice Address - Street 1:365 PEARSON DR
Practice Address - Street 2:SUITE 5
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3360
Practice Address - Country:US
Practice Address - Phone:559-788-2175
Practice Address - Fax:559-788-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38108207R00000X, 261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB80961Medicare UPIN