Vivek Kantayya, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-12703 Issued in ID

Practice address

300 S 23Rd St
Boise, ID 83702-9100

Phone

(208) 344-3512

Fax

(208) 344-4898

NPI assigned

Nov 23, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• KSB Medical Group, Inc.

  • Family Medicine Physician
  • Dixon, IL
  • NPI 1073592119
  NPD (past)
• KSB Medical Group, Inc.

  • Eyewear Supplier
  • Dixon, IL
  • NPI 1306814603
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433808000000",
    "number": "1437132479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3063 S OLD HICKORY ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837165812",
            "telephone_number": "815-871-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S 23RD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837029100",
            "telephone_number": "208-344-3512",
            "fax_number": "208-344-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANTAYYA",
        "first_name": "VIVEK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-23",
        "last_updated": "2015-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036081072",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-12703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036081072",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katherine Dolores Kane, PH.D.
• Peter L Kane
• Albert Kang
• Kenneth Richard Kannenberg, CRNA
• J. Chris Christopher Kantarian, MD
• Carl Behram Kapadia, M.D., M.SC.
• Jessica Mary Kapinos, PMHNP-BC
• Deprise Lynn Kappel, LCPC
• Beth Anne Kappes, MSPT
• Egishe Karapetyan, MD

• Family Medicine Physician in Boise, ID
• Providers in Boise, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.