Provider Demographics
NPI:1275601775
Name:REDDY, SANDEEP K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 E MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5027
Mailing Address - Country:US
Mailing Address - Phone:213-266-5600
Mailing Address - Fax:213-477-2344
Practice Address - Street 1:2040 E MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:213-266-5600
Practice Address - Fax:213-477-2344
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65510207RH0003X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH22835Medicare UPIN