1851350771 NPI number — DR. PRAKASH K YAKKUNDI MD

Table of content: DR. PRAKASH K YAKKUNDI MD (NPI 1851350771)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851350771 NPI number — DR. PRAKASH K YAKKUNDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAKKUNDI
Provider First Name:
PRAKASH
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YAKKUNDI
Provider Other First Name:
P
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851350771
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12370 HESPERIA RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
VICTORVILLE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92395-7719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-245-4747
Provider Business Mailing Address Fax Number:
760-261-6451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12408 HESPERIA RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92395-7718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-553-7000
Provider Business Practice Location Address Fax Number:
760-261-6451
Provider Enumeration Date:
03/20/2006

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: 207R00000X , with the licence number:  35-042385 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: C54968 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0399724 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34127919700 . This is a "WORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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