Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2016 | HI |
NPI | 1174690473 |
---|---|
Provider Name | Dr. Vijaya D. Reddy |
First Address | Honolulu, HI 96826-1001 |
Second Address | Honolulu, HI 96813-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
034484-01 | (05) | HI |
034484-02 | (05) | HI |
D43614 | (02) | HI |