Provider Demographics
NPI:1477522589
Name:DUDYALA, VIJAYA (MD)
Entity type:Individual
Prefix:MRS
First Name:VIJAYA
Middle Name:
Last Name:DUDYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2930
Mailing Address - Country:US
Mailing Address - Phone:408-866-4000
Mailing Address - Fax:408-866-3999
Practice Address - Street 1:828 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2930
Practice Address - Country:US
Practice Address - Phone:408-866-4000
Practice Address - Fax:408-866-3999
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A794660Medicaid
H79963Medicare UPIN
00A794660Medicare PIN
CA00A794660Medicaid