Provider Demographics
NPI:1851350771
Name:YAKKUNDI, PRAKASH K (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAKASH
Middle Name:K
Last Name:YAKKUNDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:P
Other - Middle Name:K
Other - Last Name:YAKKUNDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:12370 HESPERIA RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7719
Mailing Address - Country:US
Mailing Address - Phone:760-245-4747
Mailing Address - Fax:760-261-6451
Practice Address - Street 1:12408 HESPERIA RD
Practice Address - Street 2:SUITE 2
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7718
Practice Address - Country:US
Practice Address - Phone:760-553-7000
Practice Address - Fax:760-261-6451
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-042385207R00000X
CAC54968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399724Medicaid
OH34127919700OtherWORKERS COMP
110240021Medicare PIN
OH0399724Medicaid
A78040Medicare UPIN