Provider Demographics
NPI:1902347313
Name:KEMPARAJURS, SAMYUKTHA VANI (MD)
Entity type:Individual
Prefix:
First Name:SAMYUKTHA
Middle Name:VANI
Last Name:KEMPARAJURS
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 1:501 PARKER PL UNIT 200
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-2229
Mailing Address - Country:US
Mailing Address - Phone:502-222-7144
Mailing Address - Fax:
Practice Address - Street 1:501 PARKER PL UNIT 200
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-2229
Practice Address - Country:US
Practice Address - Phone:502-222-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-17
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92110207Q00000X, 207Q00000X
KY53626207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100569380Medicaid
KYK255240OtherMEDICARE