Provider Demographics
NPI:1962000141
Name:SUMAN S KUPPAHALLY, M.D. INC
Entity Type:Organization
Organization Name:SUMAN S KUPPAHALLY, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUPPAHALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-3458
Mailing Address - Street 1:2505 SAMARITAN DR STE 600
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4017
Mailing Address - Country:US
Mailing Address - Phone:408-358-3458
Mailing Address - Fax:408-693-3614
Practice Address - Street 1:2505 SAMARITAN DR STE 600
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4017
Practice Address - Country:US
Practice Address - Phone:408-358-3458
Practice Address - Fax:408-693-3614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-11
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty