Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A69021 | CA |
Y | 208600000X | Surgeon | A69021 | CA |
N | 2086S0129X | Vascular Surgeon | A69021 | CA |
NPI | 1114927241 |
---|---|
Provider Name | Dr. Kranthi Kumar Achanta |
First Address | Fremont, CA 94538-5818 |
Second Address | Fremont, CA 94538-5818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 05/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A690210 | (05) | CA |
A69021 | LICENSE (01) | CA |
H53120 | (02) | CA |