Provider Demographics
NPI:1861583973
Name:DHEPYASUVARN, SUKHANTAR (DPM)
Entity type:Individual
Prefix:
First Name:SUKHANTAR
Middle Name:
Last Name:DHEPYASUVARN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SUKHANTAR
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:116 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-2328
Mailing Address - Country:US
Mailing Address - Phone:785-242-3310
Mailing Address - Fax:
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2328
Practice Address - Country:US
Practice Address - Phone:785-242-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSP190213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist