Provider Demographics
NPI:1588778435
Name:REDDY, KIRAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:
Last Name:REDDY
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 1:7045 N MAPLE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8008
Mailing Address - Country:US
Mailing Address - Phone:559-326-7393
Mailing Address - Fax:559-369-2488
Practice Address - Street 1:7045 N MAPLE AVE STE 108
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8008
Practice Address - Country:US
Practice Address - Phone:559-326-7393
Practice Address - Fax:559-369-2488
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA055459208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A554590Medicaid
CA00A554590Medicaid
CAA055459Medicare UPIN