Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 43123 | AZ |
Y | 207KA0200X | Allergist | A30703 | CA |
NPI | 1528012325 |
---|---|
Provider Name | Dr. Rao R Kosaraju |
First Address | Fremont, CA 94538-1731 |
Second Address | Fremont, CA 94538-1731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 24/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E91078 | (02) | IN |
GR0043790 | (05) | CA |