Provider Demographics
NPI:1508905688
Name:RAO, KAMINENI S (MD)
Entity Type:Individual
Prefix:
First Name:KAMINENI
Middle Name:S
Last Name:RAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11015 OLSON DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-635-5375
Mailing Address - Fax:916-635-2145
Practice Address - Street 1:11015 OLSON DR
Practice Address - Street 2:SUITE 3
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:916-635-5375
Practice Address - Fax:916-635-2145
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2011-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA348970207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A348970Medicaid
CA00A348970Medicare ID - Type Unspecified
A27620Medicare UPIN