Healthcare Provider Details

I. General information

NPI: 1457522567
Provider Name (Legal Business Name): KD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W I ST
LOS BANOS CA
93635-3479
US

IV. Provider business mailing address

311 W I ST
LOS BANOS CA
93635-3479
US

V. Phone/Fax

Practice location:
  • Phone: 209-826-6444
  • Fax: 209-826-6464
Mailing address:
  • Phone: 209-826-6444
  • Fax: 209-826-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA119932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA109208
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KARTHIKEYA DEVIREDDY
Title or Position: OWNER / MEDICAL DIRECTOR
Credential:
Phone: 209-826-2222