Provider Demographics
NPI:1750065322
Name:KUNDULA MEDICAL CORPORATION
Entity type:Organization
Organization Name:KUNDULA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-302-1019
Mailing Address - Street 1:29851 AVENTURA STE M
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2014
Mailing Address - Country:US
Mailing Address - Phone:949-459-4820
Mailing Address - Fax:949-669-7220
Practice Address - Street 1:29851 AVENTURA STE M
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2014
Practice Address - Country:US
Practice Address - Phone:949-459-4820
Practice Address - Fax:949-669-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty