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NPI Code Detail

MEDICARE: DAMAYANTHI KALISETTI MD

MEDICARE: DAMAYANTHI KALISETTI MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA87495CA

General Provider Information

NPI Number : 1205813532
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMAYANTHI KALISETTI MD
Provider Business Mailing Address
First Line : 325 DISTEL CIR
Second Line :
City : LOS ALTOS
State : CA
Zip : 94022-1408
Country : US
Telephone Number : 925-875-6100
Fax Number :
Provider Business Practice Location Address
First Line : 4050 DUBLIN BLVD.
Second Line :
City : DUBLIN
State : CA
Zip : 94568-3112
Country : US
Telephone Number : 925-875-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 05/26/2020

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