Provider Demographics
NPI:1588898431
Name:KANDASWAMY, AMSAVANI (MD)
Entity type:Individual
Prefix:DR
First Name:AMSAVANI
Middle Name:
Last Name:KANDASWAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 BUTTERCUP CT
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-9531
Mailing Address - Country:US
Mailing Address - Phone:209-819-9254
Mailing Address - Fax:
Practice Address - Street 1:300 S HIGHLAND SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-6504
Practice Address - Country:US
Practice Address - Phone:951-769-5378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 107128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine