Provider Demographics
NPI:1659873701
Name:KUNDARGI, HEMLATA KIRAN
Entity Type:Individual
Prefix:
First Name:HEMLATA
Middle Name:KIRAN
Last Name:KUNDARGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10890 SANTA TERESA DR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-4725
Mailing Address - Country:US
Mailing Address - Phone:408-306-6896
Mailing Address - Fax:
Practice Address - Street 1:20555 PROSPECT RD
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5212
Practice Address - Country:US
Practice Address - Phone:408-306-6896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86066307133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered