Provider Demographics
NPI:1285897421
Name:VISWANATHAN, DUSHYANT (MD)
Entity type:Individual
Prefix:
First Name:DUSHYANT
Middle Name:
Last Name:VISWANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6236 SALE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1725
Mailing Address - Country:US
Mailing Address - Phone:888-250-2246
Mailing Address - Fax:844-233-7639
Practice Address - Street 1:21900 BURBANK BLVD
Practice Address - Street 2:# 300
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6469
Practice Address - Country:US
Practice Address - Phone:888-250-2246
Practice Address - Fax:844-233-7639
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128469207R00000X
MDD71586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA043179600Medicaid
CA043179600Medicaid
CA043179600Medicare Oscar/Certification