Healthcare Provider Details

I. General information

NPI: 1952544595
Provider Name (Legal Business Name): KRISHNA SUMANTH SIRUGUPPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 34TH ST
BAKERSFIELD CA
93301-2237
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL # SC05
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 661-541-0492
  • Fax:
Mailing address:
  • Phone: 559-353-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA154033
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA154033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: