Provider Demographics
NPI:1508978909
Name:VUNNAMADALA, SYAM PRASAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SYAM
Middle Name:PRASAD
Last Name:VUNNAMADALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 VIA GIADA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1623
Mailing Address - Country:US
Mailing Address - Phone:714-491-3928
Mailing Address - Fax:714-491-3960
Practice Address - Street 1:1211 W LA PALMA AVE STE 310
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2811
Practice Address - Country:US
Practice Address - Phone:714-491-3928
Practice Address - Fax:714-491-3960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A641890174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist