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General NPI Number Information
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NPI Number | 1568404200
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Entity Type | Individual
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Provider Name | UTHAIAH P KOKKALERA M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 18350 ROSCOE BLVD SUITE 213
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City | NORTHRIDGE
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State | CA
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Zip | 91325-4109
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Country | US
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Telephone | 818-700-7900
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Fax | 818-700-7901
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Provider Business Mailing Address
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Address Line | PO BOX 33276
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City | GRANADA HILLS
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State | CA
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Zip | 91394-3276
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Country | US
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Telephone | 818-700-7900
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Fax | 818-700-7901
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A100600
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License Number State | CA
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