Provider Demographics
NPI:1972610335
Name:CHALLAKERE, KEDARNATH KRISHNAMURTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEDARNATH
Middle Name:KRISHNAMURTHY
Last Name:CHALLAKERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60504
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-0504
Mailing Address - Country:US
Mailing Address - Phone:415-305-7019
Mailing Address - Fax:
Practice Address - Street 1:400 N PEPPER AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1801
Practice Address - Country:US
Practice Address - Phone:415-305-7019
Practice Address - Fax:415-366-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA453372084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A453370Medicaid
CA00A453370Medicaid
CA00A453370Medicare ID - Type Unspecified