Provider Demographics
NPI:1144221953
Name:KUDARAVALLI, PADMAVATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:PADMAVATHI
Middle Name:
Last Name:KUDARAVALLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2333 MOWRY AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1626
Mailing Address - Country:US
Mailing Address - Phone:510-796-0222
Mailing Address - Fax:510-796-7760
Practice Address - Street 1:2333 MOWRY AVE
Practice Address - Street 2:STE 300
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1626
Practice Address - Country:US
Practice Address - Phone:510-284-4100
Practice Address - Fax:510-794-9783
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A679640Medicaid
CAH09209Medicare UPIN
CA00A679640Medicare ID - Type Unspecified