MEDICARE: SANJAY KANDOTH MD PC

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
1	208000000X	Pediatrics Physician	9350	NV

General Provider Information

NPI Number	:	1487824223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANJAY KANDOTH MD PC

Provider Business Mailing Address
First Line	:	PO BOX 60515
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89160-0515
Country	:	US
Telephone Number	:	702-254-5437
Fax Number	:	702-254-7354

Provider Business Practice Location Address
First Line	:	3061 S MARYLAND PKWY STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-6226
Country	:	US
Telephone Number	:	702-254-5437
Fax Number	:	702-254-7354

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANJAY W KANDOTH
Credential	:	M.D.
Telephone Number	:	702-254-5437

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	08/15/2013

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