Provider Demographics
NPI:1356665293
Name:BOMMIREDDY, CHANDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHANDANA
Middle Name:
Last Name:BOMMIREDDY
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 1:1728 CHURCHILL DOWNS CIR
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-8682
Mailing Address - Country:US
Mailing Address - Phone:209-288-9520
Mailing Address - Fax:
Practice Address - Street 1:648 CAYUGA DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-5507
Practice Address - Country:US
Practice Address - Phone:510-508-8103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128148208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist