Provider Demographics
NPI:1508051566
Name:BHUPAL KOMMINENI, M.D. INC.
Entity Type:Organization
Organization Name:BHUPAL KOMMINENI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHUPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMMINENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-981-0989
Mailing Address - Street 1:1330 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE G.
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:909-949-6214
Practice Address - Street 1:1330 SAN BERNARDINO RD
Practice Address - Street 2:SUITE G.
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4928
Practice Address - Country:US
Practice Address - Phone:909-981-0989
Practice Address - Fax:909-949-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A346510Medicare PIN