Healthcare Provider Details

I. General information

NPI: 1972823672
Provider Name (Legal Business Name): KARTHIK NATARAJAN THENKONDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 S FAIR OAKS AVE STE 101
PASADENA CA
91105-2657
US

IV. Provider business mailing address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

V. Phone/Fax

Practice location:
  • Phone: 323-600-3132
  • Fax:
Mailing address:
  • Phone: 707-445-8121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA122951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: