Basic Information
Provider Information
NPI: 1013440114
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KALKAT
FirstName: PRANEET
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1449
Address2:  
City: BREA
State: CA
PostalCode: 928221449
CountryCode: US
TelephoneNumber: 7149961633
FaxNumber: 7149969267
Practice Location
Address1: 950 S ARROYO PKWY FL 3
Address2:  
City: PASADENA
State: CA
PostalCode: 911053932
CountryCode: US
TelephoneNumber: 6263040782
FaxNumber: 6266582848
Other Information
ProviderEnumerationDate: 04/05/2017
LastUpdateDate: 08/22/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/22/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XA169412CAY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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