Provider Demographics
NPI:1568404200
Name:KOKKALERA, UTHAIAH P (MD)
Entity Type:Individual
Prefix:DR
First Name:UTHAIAH
Middle Name:P
Last Name:KOKKALERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 33276
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91394-3276
Mailing Address - Country:US
Mailing Address - Phone:818-700-7900
Mailing Address - Fax:818-700-7901
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:SUITE 213
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-700-7900
Practice Address - Fax:818-700-7901
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA100600208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery