Provider Demographics
NPI:1699940379
Name:CHINTHAKINDI, RAVI K (MD)
Entity type:Individual
Prefix:
First Name:RAVI
Middle Name:K
Last Name:CHINTHAKINDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-6315
Mailing Address - Country:US
Mailing Address - Phone:916-434-8800
Mailing Address - Fax:
Practice Address - Street 1:89 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-6315
Practice Address - Country:US
Practice Address - Phone:916-434-8800
Practice Address - Fax:916-434-2679
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC127664207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0415699OtherINDEPENDENT HEALTH
NY03118958Medicaid
NY0415699OtherINDEPENDENT HEALTH