Healthcare Provider Details

I. General information

NPI: 1023364890
Provider Name (Legal Business Name): ASWATHY KUMAR VAIKOM HOUSE MD M.B.B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OU CHILDRENS HOSPITAL 1200 EVERETT DR.
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

1200 EVERETT DR # NP2350
OKLAHOMA CITY OK
73104-5047
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4411
  • Fax:
Mailing address:
  • Phone: 405-271-4411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTEP6871
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number33833
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: