Provider Demographics
NPI:1487440012
Name:DANDAMUDI, HARSHA (TAI CHI SIFU)
Entity type:Individual
Prefix:
First Name:HARSHA
Middle Name:
Last Name:DANDAMUDI
Suffix:
Gender:M
Credentials:TAI CHI SIFU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11876 SCRIPPS CREEK DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3795
Mailing Address - Country:US
Mailing Address - Phone:858-437-7474
Mailing Address - Fax:
Practice Address - Street 1:7590 CABRILLO WAY
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-0998
Practice Address - Country:US
Practice Address - Phone:858-437-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator