Provider Demographics
NPI:1467605014
Name:RACHAKONDA, AJAY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:KUMAR
Last Name:RACHAKONDA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:568 E HERNDON AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2989
Mailing Address - Country:US
Mailing Address - Phone:559-228-6600
Mailing Address - Fax:559-226-3709
Practice Address - Street 1:202 W. WILLOW ST.
Practice Address - Street 2:SUITE 302
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6238
Practice Address - Country:US
Practice Address - Phone:559-228-6600
Practice Address - Fax:559-226-3709
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2016-10-27
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Provider Licenses
StateLicense IDTaxonomies
SC32759207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC327596Medicaid
SCAA55457758Medicare PIN