Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A060104 | CA |
Y | 208600000X | Surgeon | A060104 | CA |
N | 2082S0105X | Plastic Hand Surgeon | A060104 | CA |
NPI | 1689674665 |
---|---|
Provider Name | Prasad G Kilaru |
First Address | Fremont, CA 94538-1730 |
Second Address | Fremont, CA 94538-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A601040 | (05) | CA |
G71216 | (02) | CA |