Provider Demographics
NPI:1578636890
Name:KOMMINENI, SREEDHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SREEDHAR
Middle Name:
Last Name:KOMMINENI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST, 7TH FL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-4101
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:3200 21ST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3144
Practice Address - Country:US
Practice Address - Phone:661-334-1958
Practice Address - Fax:661-334-1958
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89325207L00000X
NY232312-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89325OtherCA STATE MEDICAL LICENSE
NY232312-1OtherNYS LICENSE
CAGB501ZMedicare PIN
CACA109269Medicare PIN
CAA89325OtherCA STATE MEDICAL LICENSE
CACD4582Medicare PIN
CAZZZ34009ZMedicare PIN
CA00A893250Medicare PIN