Provider Demographics
NPI:1770584245
Name:REDDY, KADITAM V (MD)
Entity type:Individual
Prefix:DR
First Name:KADITAM
Middle Name:V
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:227 W JANSS RD STE 350
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1881
Mailing Address - Country:US
Mailing Address - Phone:805-918-5008
Mailing Address - Fax:888-587-3339
Practice Address - Street 1:227 W JANSS RD STE 350
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1881
Practice Address - Country:US
Practice Address - Phone:805-918-5008
Practice Address - Fax:888-587-3339
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207452084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR9209354OtherDEA
105895Medicare UPIN