Provider Demographics
NPI:1649400839
Name:KAMBHAMPATI, GANESH (MD)
Entity Type:Individual
Prefix:
First Name:GANESH
Middle Name:
Last Name:KAMBHAMPATI
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 1:777 CAMPUS COMMONS RD
Mailing Address - Street 2:STE 120
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-8309
Mailing Address - Country:US
Mailing Address - Phone:916-929-8564
Mailing Address - Fax:916-929-4529
Practice Address - Street 1:777 CAMPUS COMMONS RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-8309
Practice Address - Country:US
Practice Address - Phone:916-929-8564
Practice Address - Fax:916-929-4529
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN13965207RN0300X
FLME104829207R00000X
CAA117811174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007205500Medicaid
FLGU552ZMedicare PIN