Provider Demographics
NPI:1225563026
Name:GANESH, KEVIN NARESH
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:NARESH
Last Name:GANESH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15982 TUSCOLA RD STE B
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2111
Mailing Address - Country:US
Mailing Address - Phone:760-688-0084
Mailing Address - Fax:760-688-0470
Practice Address - Street 1:15982 TUSCOLA RD STE B
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2111
Practice Address - Country:US
Practice Address - Phone:760-688-0084
Practice Address - Fax:760-688-0470
Is Sole Proprietor?:No
Enumeration Date:2017-04-29
Last Update Date:2025-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169955207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease