Basic Information
| Provider Information | |||||||||
| NPI: | 1528184538 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAJ KRISHNAMURTHY | ||||||||
| FirstName: | VIDYA | ||||||||
| MiddleName: | MALINI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015074384 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5121 S COTTONWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841075701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015074384 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD2012-0679 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 57012504 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 7298413-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.