Provider Demographics
NPI:1083756001
Name:REDDY, JANGA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JANGA
Middle Name:A
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JANGA
Other - Middle Name:A
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1705 WEST DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2560
Mailing Address - Country:US
Mailing Address - Phone:323-264-4004
Mailing Address - Fax:323-264-4628
Practice Address - Street 1:284 S ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1733
Practice Address - Country:US
Practice Address - Phone:323-264-4004
Practice Address - Fax:323-264-4628
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34808207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348080Medicaid
CA00A348080Medicaid
CAC35443Medicare UPIN