Provider Demographics
NPI:1366954620
Name:KC, BASANTA (NP)
Entity type:Individual
Prefix:
First Name:BASANTA
Middle Name:
Last Name:KC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16143 WOODBRIER DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3764
Mailing Address - Country:US
Mailing Address - Phone:626-893-3700
Mailing Address - Fax:
Practice Address - Street 1:12750 CENTER COURT DR S STE 650
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8569
Practice Address - Country:US
Practice Address - Phone:323-628-8671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11286363LF0000X
CA95006273363LF0000X
NH088676-23363LF0000X
RIAPRN03136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily