Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD60819307 | WA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 125.069745 | IL |
NPI | 1124382668 |
---|---|
Provider Name | Praveen Kanneganti |
First Address | Federal Way, WA 98003-8723 |
Second Address | Federal Way, WA 98003-8723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2012 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2108169 | (05) | WA |