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General NPI Number Information
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NPI Number | 1285297747
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Entity Type | Individual
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Provider Name | C S DUSHYANT MUKKAMALA VENKATA MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 250 W 5TH ST
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City | HANFORD
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State | CA
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Zip | 93230-5029
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Country | US
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Telephone | 877-960-3426
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Fax |
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Provider Business Mailing Address
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Address Line | 305 E CENTER AVE
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City | VISALIA
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State | CA
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Zip | 93291-6331
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Country | US
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Telephone | 559-737-4775
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Fax |
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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 | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 71875
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 186873
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License Number State | CA
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