Healthcare Provider Details

I. General information

NPI: 1801961701
Provider Name (Legal Business Name): JANAKI BABY KAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD RUDNICK LANE
DOVER DE
19901
US

IV. Provider business mailing address

18 OLD RUDNICK LANE
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2616
  • Fax: 302-883-8020
Mailing address:
  • Phone: 302-674-2616
  • Fax: 302-883-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC1-0D01490
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: