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General NPI Number Information
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NPI Number | 1558935908
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Entity Type | Individual
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Provider Name | SOUMYA KAMBALAPALLI MD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 15822 S VERMONT AVE UNIT-1
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City | GARDENA
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State | CA
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Zip | 90247
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Country | US
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Telephone | 512-300-5318
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Fax |
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Provider Business Mailing Address
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Address Line | 15822 S VERMONT AVE UNIT-1
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City | GARDENA
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State | CA
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Zip | 90247
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Country | US
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Telephone | 512-300-5318
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4351047692
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A194985
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License Number State | CA
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