Provider Demographics
NPI:1730272063
Name:PARUCHURI, PHANI KUMAR (MD)
Entity type:Individual
Prefix:MR
First Name:PHANI
Middle Name:KUMAR
Last Name:PARUCHURI
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:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92885-0640
Mailing Address - Country:US
Mailing Address - Phone:714-269-5738
Mailing Address - Fax:714-695-1774
Practice Address - Street 1:1301 N ROSE DR
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3802
Practice Address - Country:US
Practice Address - Phone:714-524-4252
Practice Address - Fax:714-524-4866
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64174207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F54080Medicare UPIN
A64174CMedicare ID - Type Unspecified