Basic Information
| Provider Information | |||||||||
| NPI: | 1437297017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAZANCHI MEDICAL CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2038 | ||||||||
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| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919432038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198572569 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5555 GROSSMONT CENTER DR | ||||||||
| Address2: | |||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919423019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194650711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KAZANCHI | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6198572569 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A90062 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.