Provider Demographics
NPI:1275836959
Name:CIDAMBI, KRISHNA RAVI (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:RAVI
Last Name:CIDAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-249-6749
Mailing Address - Fax:
Practice Address - Street 1:8008 FROST ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4229
Practice Address - Country:US
Practice Address - Phone:858-939-5434
Practice Address - Fax:858-939-5471
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA118350207XS0114X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery