Provider Demographics
NPI:1639181670
Name:TUMULURI, SUDHAKAR (MD)
Entity Type:Individual
Prefix:
First Name:SUDHAKAR
Middle Name:
Last Name:TUMULURI
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 1:80 ARCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1487
Mailing Address - Country:US
Mailing Address - Phone:650-362-4111
Mailing Address - Fax:650-362-4113
Practice Address - Street 1:2340 CLAY ST
Practice Address - Street 2:FL 6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-674-5200
Practice Address - Fax:415-600-3705
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85788207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A857880Medicare PIN
CAH99668Medicare UPIN