Provider Demographics
NPI:1649371709
Name:NARRA, KISHORE BABU (MD)
Entity type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:BABU
Last Name:NARRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 MOWRY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4115
Mailing Address - Country:US
Mailing Address - Phone:510-792-1390
Mailing Address - Fax:510-792-1662
Practice Address - Street 1:716 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4115
Practice Address - Country:US
Practice Address - Phone:510-792-1390
Practice Address - Fax:510-792-1662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45586207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0387822Medicaid
CAE45318Medicare UPIN
CA0387822Medicaid