Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | A33724 | CA |
NPI | 1063417624 |
---|---|
Provider Name | Dr. Krishna Reddy |
First Address | Pomona, CA 91767-5900 |
Second Address | Pomona, CA 91767-9205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 30/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A33724 | (05) | CA |
A84568 | (02) | CA |