Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD437609 | PA |
Y | 111NI0900X | Internist | MD437609 | PA |
NPI | 1003073784 |
---|---|
Provider Name | Dr. Jyothi B Kudakandira |
First Address | Bronx, NY 10457-5524 |
Second Address | Bronx, NY 10457-7606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 02/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3751918000 | INDEPENDENCE BCBS (01) | PA |
KU2137735 | HIGHMARK BCBS (01) |