Healthcare Provider Details

I. General information

NPI: 1164458576
Provider Name (Legal Business Name): VASANTHKUMAR C KUCHANGI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 22ND ST
SIOUX FALLS SD
57105-1305
US

IV. Provider business mailing address

2501 W 22ND ST PO BOX 5046
SIOUX FALLS SD
57105-1305
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-3230
  • Fax: 605-333-5311
Mailing address:
  • Phone: 605-336-3230
  • Fax: 605-333-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4390
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: