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General NPI Number Information
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NPI Number | 1205043023
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Entity Type | Individual
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Provider Name | VIJAY MUDUNURI MD
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 1600 CREEKSIDE DR
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City | FOLSOM
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State | CA
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Zip | 95630-3444
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Country | US
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Telephone | 916-235-7790
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Fax | 916-235-7791
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Provider Business Mailing Address
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Address Line | 1111 EXPOSITION BLVD STE 300
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City | SACRAMENTO
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State | CA
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Zip | 95815-4324
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Country | US
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Telephone | 916-929-8564
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Fax | 916-929-4529
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L917191
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 29945
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A135976
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License Number State | CA
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