Provider Demographics
NPI:1962964718
Name:REDDY, KRISHNA THEJA KAKARLA (MD)
Entity type:Individual
Prefix:
First Name:KRISHNA THEJA
Middle Name:KAKARLA
Last Name:REDDY
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:UHS SOCAL MEDICAL EDUCATION CONSORTIUM,
Mailing Address - Street 2:31700 TEMECULA PARKWAY, PARKWAY SUITES # 2- GME
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-600-4337
Mailing Address - Fax:
Practice Address - Street 1:UHS SOCAL MEDICAL EDUCATION CONSORTIUM,
Practice Address - Street 2:31700 TEMECULA PARKWAY, PARKWAY SUITES # 2- GME
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-600-4337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine