Basic Information
| Provider Information | |||||||||
| NPI: | 1982840336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANDIMALLA | ||||||||
| FirstName: | YUGANDHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415348 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022415348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002258885 | ||||||||
| FaxNumber: | 5083341977 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 NW R D MIZE RD STE 206 | ||||||||
| Address2: | |||||||||
| City: | BLUE SPRINGS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640142513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8166555403 | ||||||||
| FaxNumber: | 8166555257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2009 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01080371A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME124919 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 249833 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD468189 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2018014980 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.