Provider Demographics
NPI:1316267727
Name:KANALLAKAN, TIMOTHY DONALD (CP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DONALD
Last Name:KANALLAKAN
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Gender:M
Credentials:CP
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Mailing Address - Street 1:3520 E SHIELDS AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6923
Mailing Address - Country:US
Mailing Address - Phone:559-221-1933
Mailing Address - Fax:559-221-0260
Practice Address - Street 1:3520 E SHIELDS AVE
Practice Address - Street 2:#102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6923
Practice Address - Country:US
Practice Address - Phone:559-221-1933
Practice Address - Fax:559-221-0260
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-14
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist