Provider Demographics
NPI:1316904725
Name:BHAT, KALEYATHODI NARAS (MD)
Entity type:Individual
Prefix:DR
First Name:KALEYATHODI
Middle Name:NARAS
Last Name:BHAT
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 1:2182 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2012
Mailing Address - Country:US
Mailing Address - Phone:925-685-4224
Mailing Address - Fax:925-685-6997
Practice Address - Street 1:2182 EAST ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2012
Practice Address - Country:US
Practice Address - Phone:925-685-4224
Practice Address - Fax:925-685-6997
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25677207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77751ZMedicaid
CA00A256770OtherBLUE SHIELD INDIVIDUAL PN
CA00A256770OtherBLUE SHIELD INDIVIDUAL PN
CAA24532Medicare UPIN