Healthcare Provider Details

I. General information

NPI: 1275876054
Provider Name (Legal Business Name): KIRAN KANTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2013
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD
SACRAMENTO CA
95816-5202
US

IV. Provider business mailing address

4860 Y ST STE 3700
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3588
  • Fax: 916-734-6525
Mailing address:
  • Phone: 916-703-5514
  • Fax: 916-734-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number61681
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberA162712
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number61681
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number61681
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA162712
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA162712
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: