Healthcare Provider Details

I. General information

NPI: 1255324083
Provider Name (Legal Business Name): VIKRAM KASHYAP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17720 CORPORATE WOODS DR
SAN ANTONIO TX
78259-3500
US

IV. Provider business mailing address

7810 HERMOSA HL
SAN ANTONIO TX
78256-2455
US

V. Phone/Fax

Practice location:
  • Phone: 409-457-4422
  • Fax: 314-887-7501
Mailing address:
  • Phone: 210-692-0224
  • Fax: 210-614-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberM0774
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM0774
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: