MEDICARE: DR. JANGA A REDDY M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	A34808	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083756001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANGA A REDDY M.D

Provider Business Mailing Address
First Line	:	1705 WEST DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2560
Country	:	US
Telephone Number	:	323-264-4004
Fax Number	:	323-264-4628

Provider Business Practice Location Address
First Line	:	284 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-1733
Country	:	US
Telephone Number	:	323-264-4004
Fax Number	:	323-264-4628

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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