Healthcare Provider Details

I. General information

NPI: 1154787307
Provider Name (Legal Business Name): KRANTHI NANDAN SEELABOYINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 N CALIFORNIA ST
STOCKTON CA
95204-5505
US

IV. Provider business mailing address

7273 MURRAY DR STE 18
STOCKTON CA
95210-3386
US

V. Phone/Fax

Practice location:
  • Phone: 209-469-2229
  • Fax:
Mailing address:
  • Phone: 432-703-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS9407
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number207371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: