Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 01068071A | IN |
Y | 207X00000X | Orthopaedic Surgeon | R1799 | TX |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 01068071A | IN |
NPI | 1689644528 |
---|---|
Provider Name | Dr. Shyam Kishan |
First Address | Plano, TX 75024-3457 |
Second Address | Frisco, TX 75034-3315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 04/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000674113 | ANTHEM PIN (01) | IN |
200994100 | (05) | IN |
375540701 | (05) | TX |