Provider Demographics
NPI:1063406429
Name:GOVINDAN, KALYANI (MD)
Entity type:Individual
Prefix:DR
First Name:KALYANI
Middle Name:
Last Name:GOVINDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KALYANI
Other - Middle Name:
Other - Last Name:GOVINDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6621 FANNIN ST
Mailing Address - Street 2:STE A300, MC 2-1495
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-824-5800
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:STE A300, MC 2-1495
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-5800
Practice Address - Fax:832-825-0117
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230120-1207L00000X
TXM2334207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02578325Medicaid
NY9L1631Medicare ID - Type Unspecified
NY02578325Medicaid