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Contact Information

VENKAT KIRAN KANCHUSTAMBHAM, M/D
801, BROADWAY N
FARGO, ND58102
 Phone: 701-234-2000
 Fax: 701-234-2345
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for VENKAT KIRAN KANCHUSTAMBHAM · (Male)

NPI # 1851602999
Status Active
Credentials M/D
Entity Individual
Enumeration date 06/23/2010
Last updated 07/21/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • ND License # 14482
Hospital affiliation(s)
  • JAMESTOWN REGIONAL MEDICAL CENTER - (Critical Access)
    2422 20TH ST SW
    JAMESTOWN, ND 58401
  • PERHAM MEMORIAL HOSPITAL & HOME - (Critical Access)
    1000 CONEY STREET WEST
    PERHAM, MN 56573
  • SANFORD MEDICAL CENTER FARGO - (Acute Care)
    801 BROADWAY NORTH
    FARGO, ND 58122
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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