Healthcare Provider Details

I. General information

NPI: 1790599496
Provider Name (Legal Business Name): RAJESH KUNADHARAJU MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

IV. Provider business mailing address

1801 E MARCH LN STE C300
STOCKTON CA
95210-6657
US

V. Phone/Fax

Practice location:
  • Phone: 209-464-6422
  • Fax: 209-464-0193
Mailing address:
  • Phone: 209-464-6422
  • Fax: 209-464-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJESH KUNADHARAJU
Title or Position: PRESIDENT
Credential: MD
Phone: 209-464-6422