Provider Demographics
NPI:1912271297
Name:DHORABABU, KEDARNATH (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KEDARNATH
Middle Name:
Last Name:DHORABABU
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12803 STAGECOACH LN
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3322
Mailing Address - Country:US
Mailing Address - Phone:408-476-0061
Mailing Address - Fax:
Practice Address - Street 1:12803 STAGECOACH LN
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3322
Practice Address - Country:US
Practice Address - Phone:408-476-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist