Individual
DR. SASI KIRAN PENUKONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2032 ELIZABETH AVE, SHREVEPORT, LA 71104-2123
(318) 698-0035
(318) 698-0078
Mailing address
2032 ELIZABETH AVE, SHREVEPORT, LA 71104-2123
(318) 698-0035
(318) 698-0078
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
261269
MA
2080P0205X
Pediatric Endocrinology Physician
Primary
325077
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110103822A
—
MA
Enumeration date
09/08/2009
Last updated
01/09/2023
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