MEDICARE: KPAB MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1730468745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KPAB MD INC

Provider Business Mailing Address
First Line	:	4276 54TH PLACE
Second Line	:	SUITE B
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 REO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3024
Country	:	US
Telephone Number	:	619-267-0553
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KUMARA PRATHIPATI
Credential	:	M.D.
Telephone Number	:	619-715-5276

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	09/29/2011

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