Provider Demographics
NPI:1497000848
Name:CHUNDURI, RAJESH
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:CHUNDURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3328 BORDEAUX DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3984
Mailing Address - Country:US
Mailing Address - Phone:916-715-4080
Mailing Address - Fax:
Practice Address - Street 1:1620 W EL CAMINO AVE STE 170
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-3631
Practice Address - Country:US
Practice Address - Phone:916-715-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA615691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice