Provider Demographics
NPI:1598773632
Name:NANDAKUMAR, THIRUVOIPATI (MD)
Entity Type:Individual
Prefix:
First Name:THIRUVOIPATI
Middle Name:
Last Name:NANDAKUMAR
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:PO BOX 990208
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-0208
Mailing Address - Country:US
Mailing Address - Phone:530-212-0073
Mailing Address - Fax:844-440-2311
Practice Address - Street 1:2801 EUREKA WAY
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0222
Practice Address - Country:US
Practice Address - Phone:530-241-1473
Practice Address - Fax:530-245-4139
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61639174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110144857OtherRAILROAD MEDICARE NUMBER
CAA61639OtherMEDICAL LICENSE
CA110144857OtherRAILROAD MEDICARE NUMBER