Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 15721 | WV |
Y | 207RI0011X | Interventional Cardiology | 15721 | WV |
NPI | 1043377062 |
---|---|
Provider Name | Dr. Kishore K. Challa |
First Address | South Charleston, WV 25309-1364 |
Second Address | So Charleston, WV 25309-1364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 06/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0085683000 | (05) | WV |
A61863 | (02) | WV |