Provider Demographics
NPI:1316068299
Name:KANNAN, KANNAMMA (NMD)
Entity type:Individual
Prefix:DR
First Name:KANNAMMA
Middle Name:
Last Name:KANNAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10323 RESERVE DR
Mailing Address - Street 2:# 106
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-3566
Mailing Address - Country:US
Mailing Address - Phone:858-312-5721
Mailing Address - Fax:
Practice Address - Street 1:9750 MIRAMAR RD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4560
Practice Address - Country:US
Practice Address - Phone:858-205-5152
Practice Address - Fax:866-351-7419
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-314175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath