Provider Demographics
NPI:1174577654
Name:KANDA, ANJALA (DPM)
Entity type:Individual
Prefix:DR
First Name:ANJALA
Middle Name:
Last Name:KANDA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14642 NEWPORT AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6057
Mailing Address - Country:US
Mailing Address - Phone:714-669-4422
Mailing Address - Fax:714-669-4444
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-669-4422
Practice Address - Fax:714-669-4444
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4633213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4633Medicare PIN
CA6154950001Medicare NSC
CAV05876Medicare UPIN