Provider Demographics
NPI:1245312107
Name:DANDAMUDI, SATYA NARAYANA (MD)
Entity type:Individual
Prefix:
First Name:SATYA
Middle Name:NARAYANA
Last Name:DANDAMUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SATYANARAYANA
Other - Middle Name:
Other - Last Name:DANDAMUDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:44215 15TH ST W
Mailing Address - Street 2:STE 103
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4014
Mailing Address - Country:US
Mailing Address - Phone:661-948-4429
Mailing Address - Fax:661-940-6305
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:STE 103
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4014
Practice Address - Country:US
Practice Address - Phone:661-948-4429
Practice Address - Fax:661-940-6305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321571Medicaid
A84317Medicare UPIN