Provider Demographics
NPI:1104369552
Name:KADITAM V REDDY, M.D., INC.
Entity Type:Organization
Organization Name:KADITAM V REDDY, M.D., INC.
Other - Org Name:KADITAM V. REDDY, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KADITAM
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-918-5008
Mailing Address - Street 1:227 W JANSS RD STE 350
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1881
Mailing Address - Country:US
Mailing Address - Phone:805-918-5008
Mailing Address - Fax:888-587-3339
Practice Address - Street 1:227 W JANSS RD STE 350
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1881
Practice Address - Country:US
Practice Address - Phone:805-918-5008
Practice Address - Fax:888-587-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-01
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA702452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA105895Medicare UPIN