Healthcare Provider Details

I. General information

NPI: 1407809304
Provider Name (Legal Business Name): HEMANT S KUDRIMOTI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 CREEKSIDE DR STE 170
FOLSOM CA
95630-3495
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-4825
  • Fax: 916-984-2055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number32763
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number32763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: