Healthcare Provider Details

I. General information

NPI: 1508155227
Provider Name (Legal Business Name): SWATI KANNAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8899 UNIVERSITY CENTER LN
SAN DIEGO CA
92122-1013
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8322
  • Fax: 858-657-1610
Mailing address:
  • Phone: 858-249-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA137129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: