Basic Information
| Provider Information | |||||||||
| NPI: | 1578636890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOMMINENI | ||||||||
| FirstName: | SREEDHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HARRISON ST, 7TH FL | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946123429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106254101 | ||||||||
| FaxNumber: | 8777384262 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 21ST ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933013144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613341958 | ||||||||
| FaxNumber: | 6613341958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2006 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A89325 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 232312-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | A89325 | 01 | CA | CA STATE MEDICAL LICENSE | OTHER | 232312-1 | 01 | NY | NYS LICENSE | OTHER |