Provider Demographics
NPI:1720164536
Name:GENDO, KARNA (MD)
Entity Type:Individual
Prefix:
First Name:KARNA
Middle Name:
Last Name:GENDO
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 1:370 N WIGET LN
Mailing Address - Street 2:STE 210
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2452
Mailing Address - Country:US
Mailing Address - Phone:925-935-6252
Mailing Address - Fax:925-935-7611
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:BUILDING 2, SUITE 209
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-935-6252
Practice Address - Fax:925-930-0942
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035775207K00000X, 208M00000X
CAA89530207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3741OtherINTERNAL ID-MOTOR VEHICLE ID
WA8247983Medicaid
AB10581Medicare ID - Type Unspecified
WA8247983Medicaid