Healthcare Provider Details

I. General information

NPI: 1356304539
Provider Name (Legal Business Name): SHYAM KESAVANKUTTY NAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 17TH ST
BAKERSFIELD CA
93301-4203
US

IV. Provider business mailing address

PO BOX 22230
BAKERSFIELD CA
93390-2230
US

V. Phone/Fax

Practice location:
  • Phone: 661-633-1983
  • Fax: 661-633-1101
Mailing address:
  • Phone: 661-633-1983
  • Fax: 661-633-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA56115
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA56115
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA56115
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: