Provider Demographics
NPI:1366590671
Name:SHENOY, PRAKASH N (MD)
Entity type:Individual
Prefix:
First Name:PRAKASH
Middle Name:N
Last Name:SHENOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1736 W MEDICAL CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1854
Mailing Address - Country:US
Mailing Address - Phone:714-635-1781
Mailing Address - Fax:714-277-4063
Practice Address - Street 1:1736 W MEDICAL CENTER DR
Practice Address - Street 2:SUITE A
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1854
Practice Address - Country:US
Practice Address - Phone:714-635-1781
Practice Address - Fax:714-277-4063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA33138207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27049Medicare UPIN