Healthcare Provider Details

I. General information

NPI: 1639929235
Provider Name (Legal Business Name): SAI KIRAN CHERUKURI MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 08/09/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1000
  • Fax:
Mailing address:
  • Phone: 916-781-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number210793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: