Provider Demographics
NPI:1336482967
Name:KAIPU HEALTHCARE, INC.
Entity Type:Organization
Organization Name:KAIPU HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOMASEKHARA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:KAIPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-699-2270
Mailing Address - Street 1:18564 US HIGHWAY 18
Mailing Address - Street 2:SUITE 105
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2312
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:888-847-5757
Practice Address - Street 1:18564 US HIGHWAY 18
Practice Address - Street 2:SUITE 105
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2312
Practice Address - Country:US
Practice Address - Phone:760-242-7777
Practice Address - Fax:888-847-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112037207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty