Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A73939 | CA |
NPI | 1023025863 |
---|---|
Provider Name | Venu M Kondle |
First Address | Yuba City, CA 95991-2971 |
Second Address | Yuba City, CA 95991-2971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 17/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A739390 | (05) | CA |
G80101 | (02) | |
P00355059 | MEDICARE RAILROAD # (01) |