=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114014172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIRMALA KANNAN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2006
-----------------------------------------------------
Last Update Date | 06/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1090 LA PLAYA DR
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94545-2142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-785-5555
-----------------------------------------------------
Fax | 510-280-3116
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1507 S HIAWASSEE RD STE 107
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-5706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-574-3778
-----------------------------------------------------
Fax | 650-574-0353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | ME129839
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A52786
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------