MEDICARE: KURUGANTI R. REDDY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1578757969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KURUGANTI R. REDDY M.D.

Provider Business Mailing Address
First Line	:	530 W BADILLO ST STE B
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3787
Country	:	US
Telephone Number	:	626-331-8202
Fax Number	:	626-339-8176

Provider Business Practice Location Address
First Line	:	530 W BADILLO ST
Second Line	:	STE B
City	:	COVINA
State	:	CA
Zip	:	91722-3787
Country	:	US
Telephone Number	:	626-331-8202
Fax Number	:	626-339-8176

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KURUGANTI R REDDY SR.
Credential	:	M.D.
Telephone Number	:	626-331-8202

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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