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General NPI Number Information
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NPI Number | 1306925680
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Entity Type | Organization
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Legal Business Name | NIRMALA KANNAN, M.D.
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 1090 LA PLAYA DR
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City | HAYWARD
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State | CA
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Zip | 94545-2142
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Country | US
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Telephone | 510-785-5555
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Fax | 510-280-3116
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Provider Business Mailing Address
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Address Line | PO BOX 4760
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City | FOSTER CITY
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State | CA
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Zip | 94404-0760
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Country | US
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Telephone | 650-574-3778
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Fax | 650-574-0353
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Authorized Official
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Title or Position | OWNER
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Name | NIRMALA KANNAN
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Credential | M.D.
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Telephone | 650-574-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A52786
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License Number State | CA
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