1174979462 NPI number — MR. GAUTHAM REDDY KANDUKURI M.D.

Table of content: MORGAN M TENTIS MD (NPI 1104620699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174979462 NPI number — MR. GAUTHAM REDDY KANDUKURI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANDUKURI
Provider First Name:
GAUTHAM
Provider Middle Name:
REDDY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174979462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2301 HOLMES STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-404-4175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 343
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REEDSPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97467-0343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-800-9020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  14217294-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: MD211277 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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