Healthcare Provider Details

I. General information

NPI: 1467605014
Provider Name (Legal Business Name): AJAY KUMAR RACHAKONDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 W. WILLOW ST. SUITE 302
VISALIA CA
93291-6238
US

IV. Provider business mailing address

568 E HERNDON AVE SUITE 302
FRESNO CA
93720-2989
US

V. Phone/Fax

Practice location:
  • Phone: 559-228-6600
  • Fax: 559-226-3709
Mailing address:
  • Phone: 559-228-6600
  • Fax: 559-226-3709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number32759
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: