Provider Demographics
NPI:1740514918
Name:REDDY, KURUGANTI A (MD)
Entity type:Individual
Prefix:
First Name:KURUGANTI
Middle Name:A
Last Name:REDDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITHA
Other - Middle Name:
Other - Last Name:REDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7660 BEVERLY BLVD APT 451
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2747
Mailing Address - Country:US
Mailing Address - Phone:626-347-8178
Mailing Address - Fax:
Practice Address - Street 1:7660 BEVERLY BLVD APT 451
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2747
Practice Address - Country:US
Practice Address - Phone:626-347-8178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126246207R00000X
PAMT194287207R00000X
NJ25MA08789100207R00000X
PAMD440634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine