Healthcare Provider Details

I. General information

NPI: 1528977501
Provider Name (Legal Business Name): HEMANTH KESANI VENKATA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16850 BEAR VALLEY RD
VICTORVILLE CA
92395-5794
US

IV. Provider business mailing address

16950 JASMINE ST APT 135
VICTORVILLE CA
92395-5711
US

V. Phone/Fax

Practice location:
  • Phone: 760-241-8000
  • Fax:
Mailing address:
  • Phone: 470-406-0068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: