Provider Demographics
NPI:1659712420
Name:KUNADHARAJU, RAJESH (MBBS)
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:
Last Name:KUNADHARAJU
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E MARCH LN STE C300
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6657
Mailing Address - Country:US
Mailing Address - Phone:209-464-6422
Mailing Address - Fax:209-464-0193
Practice Address - Street 1:1801 E MARCH LN STE C300
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6657
Practice Address - Country:US
Practice Address - Phone:209-464-6422
Practice Address - Fax:209-464-0193
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA176071207R00000X, 207RP1001X, 207RC0200X
NE7045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease