Provider Demographics
NPI:1639242886
Name:RAO V SUNKAVALLY MD
Entity Type:Organization
Organization Name:RAO V SUNKAVALLY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:V
Authorized Official - Last Name:SUNKAVALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-790-9025
Mailing Address - Street 1:1999 MOWRY AVE
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-790-9025
Mailing Address - Fax:510-790-9080
Practice Address - Street 1:1999 MOWRY AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-790-9025
Practice Address - Fax:510-790-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39536208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A395360Medicaid
C03992Medicare UPIN
CA00A395360Medicare PIN