Basic Information
| Provider Information | |||||||||
| NPI: | 1417974247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PEDDI | ||||||||
| FirstName: | VENKAT | ||||||||
| MiddleName: | RAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 254947 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958654947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168546975 | ||||||||
| FaxNumber: | 9168546844 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 CLAY ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941151932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156001063 | ||||||||
| FaxNumber: | 4156001065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/01/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | C51237 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | CG873Z | 01 | CA | MEDICARE PIN (LOCALITY 9) | OTHER | P00814837 | 01 | CA | MEDICARE RAILROAD | OTHER | CG873W | 01 | CA | MEDICARE PIN (LOCALITY 99 SOUTHERN CA) | OTHER |