Provider Demographics
NPI:1629198171
Name:MOTHKURI, KAVITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITHA
Middle Name:
Last Name:MOTHKURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAVITHA
Other - Middle Name:
Other - Last Name:KUNDHARAPU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:4 BLAZING STAR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3036
Mailing Address - Country:US
Mailing Address - Phone:949-651-6370
Mailing Address - Fax:
Practice Address - Street 1:4 BLAZING STAR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3036
Practice Address - Country:US
Practice Address - Phone:949-651-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96430251E00000X, 251G00000X, 261QP2300X, 281P00000X, 282E00000X, 282N00000X, 291U00000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251E00000XAgenciesHome Health
Not Answered251G00000XAgenciesHospice Care, Community Based
Not Answered261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Not Answered281P00000XHospitalsChronic Disease Hospital
Not Answered282E00000XHospitalsLong Term Care Hospital
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered291U00000XLaboratoriesClinical Medical Laboratory
Not Answered320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities