Basic Information
| Provider Information | |||||||||
| NPI: | 1255324083 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KASHYAP | ||||||||
| FirstName: | VIKRAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4242 MEDICAL DR | ||||||||
| Address2: | SUITE 6300 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106920224 | ||||||||
| FaxNumber: | 2106148165 | ||||||||
| Practice Location | |||||||||
| Address1: | 4242 MEDICAL DR | ||||||||
| Address2: | SUITE 6300 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106920224 | ||||||||
| FaxNumber: | 2106148165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 04/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | M0774 | TX | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0800X | M0774 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | BK9141918 | 01 | TX | DEA | OTHER | K0139190 | 01 | TX | DPS | OTHER | 173563101 | 05 | TX | MEDICAID |