Provider Demographics
NPI:1124213756
Name:KONURU, KATHYAYINI J (MD)
Entity type:Individual
Prefix:
First Name:KATHYAYINI
Middle Name:J
Last Name:KONURU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N COUNTRY CLUB DR
Mailing Address - Street 2:STE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-5700
Mailing Address - Country:US
Mailing Address - Phone:480-963-1853
Mailing Address - Fax:
Practice Address - Street 1:1343 N ALMA SCHOOL RD
Practice Address - Street 2:STE 160
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5941
Practice Address - Country:US
Practice Address - Phone:480-963-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine