Healthcare Provider Details

I. General information

NPI: 1164683066
Provider Name (Legal Business Name): JYOTHI KUNDUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 NACOGDOCHES RD STE. 116
SAN ANTONIO TX
78247-1903
US

IV. Provider business mailing address

14100 NACOGDOCHES RD STE. 116
SAN ANTONIO TX
78247-1903
US

V. Phone/Fax

Practice location:
  • Phone: 210-653-8989
  • Fax: 210-590-4608
Mailing address:
  • Phone: 210-653-8989
  • Fax: 210-590-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP0423
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: