Provider Demographics
NPI:1720114093
Name:GADDIPATI, KISHORE V (MD)
Entity Type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:V
Last Name:GADDIPATI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:4060 FOURTH AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2120
Mailing Address - Country:US
Mailing Address - Phone:619-291-6064
Mailing Address - Fax:619-291-3492
Practice Address - Street 1:4060 FOURTH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-291-6064
Practice Address - Fax:619-291-3492
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2013-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA111638207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADN434WMedicare PIN