Healthcare Provider Details

I. General information

NPI: 1841976370
Provider Name (Legal Business Name): ARJUN PONDURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8791 ALTA DR STE 4041
LAS VEGAS NV
89145-8578
US

V. Phone/Fax

Practice location:
  • Phone: 310-786-7204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberLL4063
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: