Provider Demographics
NPI:1457522567
Name:KD MEDICAL GROUP,INC.
Entity Type:Organization
Organization Name:KD MEDICAL GROUP,INC.
Other - Org Name:PADRES MEDICAL IMAGING,INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARTHIKEYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-826-2222
Mailing Address - Street 1:311 W I ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-3479
Mailing Address - Country:US
Mailing Address - Phone:209-826-6444
Mailing Address - Fax:209-826-6464
Practice Address - Street 1:311 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3479
Practice Address - Country:US
Practice Address - Phone:209-826-6444
Practice Address - Fax:209-826-6464
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KD MEDICAL GROUP,INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119932207Q00000X
CA207R00000X, 2085R0202X
CAA109208208000000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty