Provider Demographics
NPI:1114927241
Name:ACHANTA, KRANTHI KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KRANTHI
Middle Name:KUMAR
Last Name:ACHANTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39141 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5818
Mailing Address - Country:US
Mailing Address - Phone:510-248-1000
Mailing Address - Fax:510-608-6055
Practice Address - Street 1:39141 CIVIC CENTER DR
Practice Address - Street 2:SUITE 335
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5818
Practice Address - Country:US
Practice Address - Phone:510-248-1450
Practice Address - Fax:510-742-8244
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69021208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A690210Medicaid
CAA69021OtherLICENSE
CAH53120Medicare UPIN
CA00A690210Medicare ID - Type Unspecified