Basic Information
| Provider Information | |||||||||
| NPI: | 1821280207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOGINENI | ||||||||
| FirstName: | VIJAYA | ||||||||
| MiddleName: | KUMAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 855 A AVE NE STE 400 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524025064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193633565 | ||||||||
| FaxNumber: | 3193634001 | ||||||||
| Practice Location | |||||||||
| Address1: | 855 A AVE NE STE 400 | ||||||||
| Address2: | |||||||||
| City: | CEDAR RAPIDS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 524025064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193633565 | ||||||||
| FaxNumber: | 3193634001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 06/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 40972 | IA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.