Healthcare Provider Details

I. General information

NPI: 1598773632
Provider Name (Legal Business Name): THIRUVOIPATI NANDAKUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 EUREKA WAY
REDDING CA
96001-0222
US

IV. Provider business mailing address

PO BOX 990208
REDDING CA
96099-0208
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-1473
  • Fax: 530-245-4139
Mailing address:
  • Phone: 530-212-0073
  • Fax: 844-440-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA61639
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA61639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: