Provider Demographics
NPI:1306928262
Name:KIKANI, DIVYAKANT J (MD)
Entity type:Individual
Prefix:DR
First Name:DIVYAKANT
Middle Name:J
Last Name:KIKANI
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 1:1800 WESTERN AVE
Mailing Address - Street 2:SUITE #404
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1356
Mailing Address - Country:US
Mailing Address - Phone:909-887-1184
Mailing Address - Fax:
Practice Address - Street 1:1800 WESTERN AVE
Practice Address - Street 2:SUITE #404
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1356
Practice Address - Country:US
Practice Address - Phone:909-887-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A347172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27557Medicare UPIN