Healthcare Provider Details

I. General information

NPI: 1558360578
Provider Name (Legal Business Name): KANAKAM DILEEPAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 W 74TH ST STE 3
SHAWNEE MISSION KS
66204-2204
US

IV. Provider business mailing address

8901 W 74TH ST STE 3
SHAWNEE MISSION KS
66204-2204
US

V. Phone/Fax

Practice location:
  • Phone: 913-384-5775
  • Fax: 913-384-3990
Mailing address:
  • Phone: 913-384-5775
  • Fax: 913-384-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20216
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6D12
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA42871
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20216
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR6D12
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA42871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: