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General NPI Number Information
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NPI Number | 1982640892
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Entity Type | Organization
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Legal Business Name | KANNAN CLINIC, P.C.
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5120 S WESTERN AVE STE. 104
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5013
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Country | US
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Telephone | 605-271-3900
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Fax | 605-271-3902
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Provider Business Mailing Address
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Address Line | 5120 S WESTERN AVE STE. 104
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City | SIOUX FALLS
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State | SD
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Zip | 57108-5013
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Country | US
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Telephone | 605-271-3900
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Fax | 605-271-3902
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Authorized Official
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Title or Position | OWNER/PSYCHIATRIST
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Name | DR. HARI DASAN KANNAN
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Credential | M.D.
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Telephone | 605-728-1902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3486
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License Number State | SD
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