Provider Demographics
NPI:1356392781
Name:KANKIPATI, SHOBA (MD)
Entity type:Individual
Prefix:DR
First Name:SHOBA
Middle Name:
Last Name:KANKIPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4721 DALLAS RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531
Mailing Address - Country:US
Mailing Address - Phone:925-778-0679
Mailing Address - Fax:925-778-3567
Practice Address - Street 1:400 TAYLOR BLVD,
Practice Address - Street 2:SUITE 201
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523
Practice Address - Country:US
Practice Address - Phone:925-687-2570
Practice Address - Fax:925-687-2847
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80382207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ39149ZMedicare PIN
CAI52071Medicare UPIN
CAZZZ39155ZMedicare PIN
CAZZZ39156ZMedicare PIN
CAZZZ26779ZMedicare PIN